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Clinical QuestionE„§ˆê——‚Ö


CQ 1
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—v–ń
► 
ˆê”Ê“I‚É—p‚ą‚ç‚ê‚Ä‚ą‚é‚Ì‚ÍWHO •Ș—Ț‚ÆEnzinger & Weiss •Ș—Ț‚Ć‚ ‚éD
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“î•”Žîᇂ̕Ș—Ț‚ĆĆ‚àˆê”Ê“I‚È‚Ì‚ÍWHO •Ș—ȚiT2R00001j‚Ć‚ ‚éDEnzinger & Weiss ‚Ì•Ș—ȚiT2R00002j‚à‚”‚΂”‚Ηp‚ą‚ç‚ê‚Ä‚ą‚éDŒ»Žž“_‚ƍƐV‚Ì2002 ”N‚ÌWHO •Ș—Ț‚Ƃ́C‘O‰ń‚ɔ䂌‘ć‚«‚ȉü’ù‚ȘŽl“_‚ƍs‚í‚ê‚œi•\1C‘ŸŽš•”•ȘjDˆê“_–ڂ͐V‚œ‚ɗǁEˆ««’†ŠÔŽîᇂȘĘ‚Ż‚ç‚ê‚œ‚±‚Æ‚Ć‚ ‚éD‚±‚ê‚Í‚ł‚ç‚ɋǏŠ”j‰ó«‚É‘B‚·‚é‚Ș‰“Šu“]ˆÚ‚Í‚”‚È‚ąintermediateilocally aggressivej‚ƁC‚Ü‚ê‚É“]ˆÚ‚·‚éintermediateirarely metastasizingj‚ɍŚ•Ș‚ł‚ê‚œD—Տ°‰Æ‚É‚Æ‚Á‚Ä‚Í•Ș‚è‚â‚·‚­—L—p‚È•Ș—Ț‚Æ‚ą‚Š‚éD“ń“_–Ú‚Í‚±‚ê‚Ü‚ĆĆ‚à•p“x‚Ș‚‚ą‚Æ‚ł‚ê‚Ä‚«‚œ‘œŒ`Œ^‚̈««üˆÛ«‘gD‹…Žîimalignant fibrous histiocytomaFMFHj‚Ì“Ż‹`Œê‚Æ‚”‚Ä–ą•Ș‰»‘œŒ`“śŽîiundifferentiated pleomorphic sarcomaj‚Æ‚ą‚€Œê‚Ș—p‚ą‚ç‚ê‚œ‚±‚Æ‚Ć‚ ‚éDŽîᇂ̕Ș‰»‚đŠî€‚É‚”‚œ–{•Ș—Ț‚É‚ ‚Á‚Ä–ą•Ș‰»iundifferentiatedj‚Æ•č‹L‚ł‚ê‚œ‚±‚Æ‚©‚çCMFH ‚͏«—ˆíœ‚ł‚ê‚é‰Â”\«‚Șl‚Š‚ç‚ê‚éDŽO“_–Ú‚Í“ûŽ™Œ^ŒŒŠÇŽü”çŽî‚È‚Ç‚đœ‚­ŒŒŠÇŽü”çŽî‚Ì‚Ù‚Æ‚ń‚Ç‚ȘŽü”獦–E‚Ö‚Ì•Ș‰»‚Ș”F‚ß‚ç‚ê‚È‚ą‚±‚Æ‚ÉŠî‚Ă‚«CŒÇĘ«üˆÛ«Žîᇁisolitary fibrous tumourj‚Æ‚Ì•č‹L‚É‚È‚Á‚œ‚±‚Æ‚Ć‚ ‚éD•ÏX“_‚ÌĆŒăŽl‚–ڂƂ”‚Ä‚ÍŠŠ–Œ«Žîᇂ̍€–Ú‚Șíœ‚ł‚ê‚œ‚±‚Æ‚Ș‚ ‚°‚ç‚ê‚éD

‚ł‚ç‚É‚ÍWHO •Ș—Ț‚Ć‚Í“î•”ŽîᇂƂ ‚é‚É‚à‚©‚©‚í‚ç‚žC––œ_Œo—R—ˆ‚ÌŽîᇂâ”畆‚ÌŽîᇁi—Č‹N«”畆üˆÛ“śŽî‚Ȃǁj‚Ș‚»‚ê‚Œ‚ê_ŒoŒnŽîᇂƔ畆‚ÌŽîᇂ̕Ș–ì‚Ć‹LÚ‚ł‚ê‚Ä‚ą‚éDŽÀ’n—Տ°Œ»ê‚ĆŒoŒ±‚·‚邱‚Æ‚Ș‘œ‚ą‚ÆŽv‚í‚ê‚éŽîᇂđ•Ê•\‚Æ‚”‚ÄWHO •Ș—Ț‚Ì“î•”ŽîᇁC––œ_ŒoŒnŽîᇂ̍€‚©‚ç”Ȑˆ‚”‚œi•\2jD

“î‚È‚šC‰»Šw—Ă–@‚̍ۂɂ”‚΂”‚Ηp‚ą‚ç‚ê‚é—pŒê‚Ć‚ ‚é‰~Œ`Ś–E“śŽî‚É‚ÍPNET/œŠO«Ewing “śŽîC‘ÙŽ™Œ^C•À‚Ń‚É–E‘ƒŒ^‰Ą–ä‹Ű“śŽî‚È‚Ç‚ȘŠÜ‚Ü‚êC‘Œ‚Ì‘œ‚­‚Ì“śŽî‚Í”ń‰~Œ`Ś–E“śŽî‚Æ‘Ì‚ł‚ê‚Ä‚ą‚éi‘æ9 ÍCQ1 ŽQÆjD

y•¶@ŒŁz
1j T2R00001
Fletcher CD, Unni KK, Mertens FFWHO Classification of Tumours, Volume 5. Pathology and Genetics of Tumours of Soft Tissue and Bone, 3rd ed, IARC PressCLyonG2002
2j T2R00002
Weiss SW, Goldblum JRFEnzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008
•\1 WHO classification of soft tissue tumours
ADIPOCYTIC TUMOURS
Benign Lipoma
Lipomatosis
Lipomatosis of nerve
Lipoblastoma/Lipoblastomatosis
Angiolipoma
Myolipoma
Chondroid lipoma
Extrarenal angiomyolipoma
Extra-adrenal myelolipoma
Spindle cell/Pleomorphic lipoma
Hibernoma
lntermediateilocally aggressivej Atypical lipomatous tumour/Well differentiated liposarcoma
Malignant Dedifferentiated liposarcoma
Myxoid liposarcoma
Round cell liposarcoma
Pleomorphic liposarcoma
Mixed-type liposarcoma
Liposarcoma, not otherwise specified
FIBROBLASTIC / MYOFIBROBLASTIC TUMOURS
Benign Nodular fasciitis
Proliferative fasciitis
Proliferative myositis
Myositis ossificans fibro-osseous pseudotumour of digits
lschaemic fasciitis
Elastofibroma
Fibrous hamartoma of infancy
Myofibroma / Myofibromatosis
Fibromatosis colli
Juvenjle hyaline fibromatosis
lnclusion body fibromatosis
Fibroma of tendon sheath
Desmoplastic fibroblastoma
Mammary-type myofibroblastoma
Calcifyjng aponeurotic fibroma
Angiomyofibroblastoma
Cellular angiofibroma
Nuchal-type fibroma
Gardner fibroma
Calcifying fibrous tumour
Giant cell angiofibroma
lntermediateilocally aggressivej Superficial fibromatosesipalmar/plantarj
Desmoid-type fibromatoses
Lipofibromatosis
lntermediateirarely metastasizingj Solitary fibrous tumour and haemangjopericytoma
iincl. lipomatous haemangiopericytomaj
lnflammatory myofibroblastic tumour
Low grade myofibroblastic sarcoma
Myxoinflammatory fibroblastic sarcoma
lnfantile fibrosarcoma
Malignant Adult fibrosarcoma
Myxofibrosarcoma
Low grade fibromyxoid sarcoma hyalinizing spindle cell tumour
Sclerosing epithelioid fibrosarcoma
SO-CALLED FIBROHISTIOCYTIC TUMOURS
Benign Giant cell tumour of tendon sheath
Diffuse-type giant cell tumour
Deep benign fibrous histiocytoma
lntermediateirarely metastasizingj Plexiform fibrohistiocytic tumour
Giant cell tumour of soft tissue
Malignant Pleomorphice MFHf / Undifferentiated pleomorphic sarcoma
Giant celle MFHf / Undifferentiated pleomorphic sarcoma with giant cells
lnflammatorye MFHf / Undifferentiated
 pleomorphic sarcoma with prominent inflammation
SMOOTH MUSCLE TUMOURS
Angioleiomyoma
Deep leiomyoma
Genital leiomyoma
Leiomyosarcomaiexcluding skinj
PERICYTICiPERIVASCULARjTUMOURS
Glomus tumouriand variantsjmalignant glomus tumour
Myopericytoma
SKELETAL MUSCLE TUMOURS
Benign Rhabdomyoma adult type
fetal type
genital type
Malignant Embryonal rhabdomyosarcomaiincl. spindle cellCbotryoidCanaplasticj
Alveolar rhabdomyosarcomaiincl. solidCanaplasticj
Pleomorphic rhabdomyosarcoma
VASCULAR TUMOURS
Benign Haemangiomas of subcut/deep soft tissueF
 capillary
 cavernous
 arteriovenous
 venous
 intramuscular
 synovial
Epithelioid haemangioma
Angiomatosis
Lymphangioma
lntermediateilocally aggressivej Kaposiform haemangioendothelioma
lntermediateirarely metastasizingj Retiform haemangioendothelioma
Papjllary intralymphatic angioendothelioma
Composite@haemangioendothelioma
Kaposi sarcoma
Malignant Epithelioid haemangioendothelioma
Angiosarcoma of soft tissue
CHONDRO-OSSEOUS TUMOURS
Soft tissue chondroma
Mesenchymal chondrosarcoma
Extraskeletal osteosarcoma
TUMOURS OF UNCERTAIN DIFFERENTIATION
Benign lntramuscular myxomaiincl. cellular variantj
Juxta-articular myxoma
Deepieaggressivefjangiomyxoma
Pleomorphic hyalinizing angiectatic tumour
Ectopic hamartomatous thymoma
lntermediateirarely metastasizingj Angiomatoid fibrous histiocytoma
Ossifying fibromyxoid tumouriincl. atypical / malignantj
Mixed tumour/Myoepithelioma/Parachordoma
Malignant Synovial sarcoma
Epithelioid sarcoma
Alveolar soft part sarcoma
Clear cell sarcoma of soft tissue
Extraskeletal myxoid chondrosarcoma
igchordoidhtypej
PNET / Extraskeletal Ewing tumour
 pPNET
 extraskeletal Ewing tumour
Desmoplastic small round cell tumour
Extra-renal rhabdoid tumour
Malignant mesenchymoma
Neoplasms with perivascular epithelioid cell
differentiationiPEComaj
 clear cell myomelanocytic tumour
lntimal sarcoma
•\2 •p“x‚̍‚‚ą“î•”ŽîᇁiWHO •Ș—Ț‚Ì“î•”ŽîᇂƐ_ŒoŒnŽîᇂ̍€‚©‚ç”Ȑˆj
Ž‰–b«Žîá‡
—ǁ@« Ž‰–bŽî
—Lj««’†ŠÔi‹ÇŠNP«j ˆÙŒ^Ž‰–bŽî
‚•Ș‰»Œ^Ž‰–b“śŽî
ˆ«@« Ž‰–b“śŽîi”S‰tŒ^C‰~Œ`Ś–EŒ^C‘œŒ`Œ^‚Ȃǁj
üˆÛ‰èŚ–E«^‹ŰüˆÛ‰èŚ–E«Žîá‡
—ǁ@« Œ‹ß«‹Ű–Œ‰Š
œ‰»«‹Ű‰Š
’e«üˆÛŽî
—Lj««’†ŠÔi‹ÇŠNP«j •\Ę«iDupuytren Œ^jüˆÛŽîÇ
ƒfƒXƒ‚ƒCƒhŒ^üˆÛŽîÇ
—Lj««’†ŠÔi‹H‚É“]ˆÚj ŒÇĘ«üˆÛ«Žîá‡
ˆ«@« ”S‰tüˆÛ“śŽî
’ራ«üˆÛ”S‰t«“śŽî
‚ą‚í‚ä‚éüˆÛ‘gD‹…«Žîá‡
—ǁ@« äFâ‹Ś–EŽî
‚Ń‚Ü‚ńŒ^‹Ś–EŽîiF‘f«ăO–ŃŒ‹ß«ŠŠ–Œ‰Šj
—Lj««’†ŠÔi‹H‚É“]ˆÚj “î•”‹Ś–EŽî
ˆ«@« –ą•Ș‰»‘œŒ`“śŽî
•œŠŠ‹ŰŽîá‡
—ǁ@« ŒŒŠÇ•œŠŠ‹ŰŽî
ˆ«@« •œŠŠ‹Ű“śŽî
ŒŒŠÇŽü”獦–E«Žîá‡
ƒOƒƒ€ƒXŽîá‡
‰Ą–ä‹ŰŽîá‡
ˆ«@« ‰Ą–ä‹Ű“śŽîi‘ÙŽ™Œ^C–E‘ƒŒ^C‘œŒ`Œ^j
ŒŒŠÇ«Žîá‡
—ǁ@« ŒŒŠÇŽî
—Lj««’†ŠÔi‹H‚É“]ˆÚj ƒJƒ|ƒW“śŽî
ˆ«@« —Ță”çŒ^ŒŒŠÇ“à”çŽî
“î•”ŒŒŠÇ“śŽî
“Eœ«Žîá‡
—ǁ@« “î•”“Žî
ˆ«@« ŠÔ—tŒn““śŽî
œŠO«œ“śŽî
––œ_Œo«Žîá‡
—ǁ@« _ŒoüˆÛŽî
_ŒoâŽî
ˆ«@« ˆ««––œ_ŒoâŽîá‡
•Ș‰»–ą’è‚ÌŽîá‡
—ǁ@« ‹Ű“à”S‰tŽî
—Lj««’†ŠÔi‹H‚É“]ˆÚj —ȚŒŒŠÇŽîŒ^üˆÛ«‘gD‹…Žî
œ‰»«üˆÛ”S‰t«Žîá‡
“î•”Ź‡Žîᇁ^‹Űă”çŽî
ˆ«@« ŠŠ–Œ“śŽî
—Ță”ç“śŽî
–E‘ƒó“î•”“śŽî
’W–ŸŚ–E“śŽî
œŠO«”S‰tŒ^““śŽî
––œ«ŒŽŽn_ŒoŠOăó—t«ŽîᇁiœŠO«Ewing “śŽîj

CQ 2
•aŠú•Ș—Ț‚Í
—v–ń
► 
AJCC system ‚đ‚Í‚¶‚ß‚Æ‚”‚āCUICC system ‚âSurgical staging system ‚Ș—p‚ą‚ç‚ê‚Ä‚ą‚éD
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•p—p‚ł‚ê‚Ä‚ą‚é‚Ì‚ÍAmerican Joint Committee on Cancer systemiAJCC systemC•\1jCUnion for International Cancer Control systemiUICC systemC•\2jC‚»‚”‚ÄSurgical staging systemi•\3j‚Ì3 ‚‚Ƃ ‚émiT2R00003jCiT2R00004jnD

AJCC system ‚ÆUICC system ‚ÍŽîá‡‚Ì‘ć‚«‚łC[‚łC‚»‚”‚Ä‘gDŠw“Iˆ««“x‚đŠî€‚É•Ș—Ț‚”‚Ä‚ą‚éD‚±‚ê‚ɑ΂”Surgical staging system ‚ÍŽîá‡‚Ì‘ć‚«‚ł‚Ș€–Ú‚É‚È‚­C[‚ł‚Ì‘ă‚í‚è‚É‹æ‰æ“à‚©ŠO‚©‚ȘŠî€‚É‚È‚Á‚Ä‚ą‚éiT2F12414jDAJCC system ‚ÆUICC system ‚ÍŒ»Ę‚܂Ɖü’ù‚Șs‚í‚ê‚Ä‚š‚èC‘æ6 ”Ć‚Í“Żˆê‚Ć‚ ‚Á‚œ‚ȘC‘æ7 ”Ć‚Ć‚ÍˆÙ‚È‚é‚à‚Ì‚Æ‚È‚Á‚œDĆV‚ÌAJCC system ‘æ7 ”Ć‚Ć‚ÍFrench Fédération Nationale des Centres de Lutte Contre Le Cancer systemiFNCLCC systemjmiT2R00003jCiT2R00004jn‚ɏ]‚ą‘gDŠw“Iˆ««“x‚đGrade 1 `3 ‚Ì3 ’iŠK‚É•Ș—Ț‚”CóĘ«‚ÌŽîá‡‚Ć‚àˆ««“x‚ȘGrade 3 ‚Ć‚ ‚ê‚ÎStage ⅢC‰“Šu“]ˆÚ‚Ș‚È‚­ƒŠƒ“ƒpß“]ˆÚ‚Ì‚Ę‚Ìê‡‚ÍStage Ⅲ‚ȂǁC‘æ6 ”Ć‚©‚ç•ÏX‚ł‚ê‚œDUICC system ‘æ7 ”Ć‚Ć‚àC‰“Šu“]ˆÚ‚Ș‚È‚­ƒŠƒ“ƒpß“]ˆÚ‚Ì‚Ę‚Ìê‡‚ÍStage Ⅲ‚ÆAJCC system ‚Æ“Ż—l‚̉ü’ù‚Șs‚í‚ê‚œD‚”‚©‚”UICC system ‚Ć‚Í‘gDŠw“Iˆ««“x‚͒ራ«“x‚ƍ‚ˆ««“x‚É‘ć•Ê‚·‚é•Ș—Ț‚ȘˆÛŽ‚ł‚êCStage Ⅱ B ‚ÆⅢ‚Ć‚ÌŽîᇂ̐[‚ł‚ÌŽæ‚舔‚ą‚àAJCC system ‚ƈقȂÁ‚œ‚à‚Ì‚Æ‚È‚Á‚œ.

y•¶@ŒŁz
1j T2R00003
Edge SB et alFAJCC Cancer Staging HandbookFfrom the AJCC Cancer Staging Manual, 7th ed, Springer, New YorkG2010, p345-355
2j T2R00004
UICCi‘Û‘΂Ș‚ń˜A‡j“ú–{ˆÏˆő‰ïTNM ˆÏˆő‰ïi–ójFTNM ˆ««Žîᇂ̕Ș—Ț“ú–{Œê”Ć ‘æ7 ”ƁC‹àŒŽo”ƁC“Œ‹žG2010Cp147-151
3j T2F12414
Enneking WF, Spanier SS, Goodman MAFA system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980G153F106-120
•\1 AJCC systemi7th ed.j*
•aŠú Žîᇂ̃TƒCƒY‚Ɛ[“x** ƒŠƒ“ƒpß“]ˆÚ ‰“Šu“]ˆÚ ‘gDŠw“Iˆ««“x
‡TA T1a, T1b N0 M0 Grade 1
‡TB T2a, T2b N0 M0 Grade 1
ⅡA T1a, T1b N0 M0 Grade 2, 3
ⅡB T2a, T2b N0 M0 Grade 2
T2a, T2b N0 M0 Grade 3
Any T N1 M0 Any Grade
‡W Any T Any N M1 Any Grade

*ƒJƒ|ƒW“śŽîCƒfƒXƒ‚ƒCƒhCæ“V«üˆÛ“śŽî‚͏œ‚­D

**T1, 5 cm ˆÈ‰șGT2, 5 cm ‚æ‚è‘ć‚«‚ąGa, óĘ«Gb, [Ę«

•\2 UICC systemi7th ed.j*
•aŠú Žîᇂ̃TƒCƒY‚Ɛ[“x** ƒŠƒ“ƒpß“]ˆÚ ‰“Šu“]ˆÚ ‘gDŠw“Iˆ««“x
‡TA T1a, T1b N0 M0 ’ራ«“x
‡TB T2a, T2b N0 M0 ’ራ«“x
ⅡA T1a, T1b N0 M0 ‚ˆ««“x
ⅡB T2a N0 M0 ‚ˆ««“x
T2b N0 M0 ‚ˆ««“x
Any T N1 M0 Any Grade
‡W Any T Any N M1 Any Grade

*ƒJƒ|ƒW“śŽîC”畆üˆÛ“śŽîCüˆÛŽîÇCŒŒŠÇ“śŽîC‚ł‚ç‚ɍd–ŒC”]CŠÇo‘ŸŠíC‚Ü‚œ‚ÍŽÀŽż‘ŸŠíi“û‘B“śŽî‚đœ‚­j‚©‚ç”­¶‚”‚œ“śŽî‚͏œ‚­D

**T1, 5 cm ˆÈ‰șGT2, 5 cm ‚æ‚è‘ć‚«‚ąGa, óĘ«Gb, [Ę«

•\3 Surgical staging system
•aŠú ‘gDŠw“Iˆ««“x Žîá‡‚Ì‹ÇĘ “]@ˆÚ
‡TA ’á ‹æ‰æ“à M0
‡TB ’á ‹æ‰æŠO M0
ⅡA ‚ ‹æ‰æ“à M0
ⅡB ‚ ‹æ‰æŠO M0
–łŠÖŒW M1

‘æ‚QÍ@‰u@Šw

Clinical QuestionE„§ˆê——‚Ö


‚Í‚¶‚ß‚É

“î•”ŽîᇁC‚±‚Ƃɗǐ«“î•”ŽîᇂɊւ”‚ẮC‚»‚Ì”­¶•p“x‚𐳊m‚É‹Lq‚”‚œ‰uŠw“I‚ÈŽ‘—ż‚Í‚Ù‚Æ‚ń‚Ç‘¶Ę‚č‚žC•ń‚ł‚ê‚Ä‚ą‚镶ŒŁ‚Ì‘œ‚­‚ÍCase series ‚Ć‚ ‚éD‚Ü‚œC•ń‚ł‚ê‚Ä‚ą‚éŽîᇂ̑œ‚­‚́C‰œ‚ç‚©‚ÌŽĄ—Ă‚Șs‚í‚ê‚œŠłŽÒC‚·‚È‚í‚żŽĄ—Ă‚đ—v‚·‚éó‘Ô‚ÌŽîᇂƂ ‚Á‚œ‚ƍl‚Š‚ç‚ê‚é‚œ‚߁CƒTƒ“ƒvƒŠƒ“ƒO‚Ì’iŠK‚©‚ç•Î‚è‚Ș‚ ‚邱‚Æ‚Í”đ‚Ż‚Ș‚œ‚ąD

‚í‚Ș‘‚Ƃ́C“ú–{źŒ`ŠO‰ÈŠw‰ï/ ‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[‚𒆐S‚Æ‚”‚āC‘S‘œE “î•”Žîᇓo˜^‚Ș1960 ”N‘ă‚æ‚èŒp‘±“I‚ɍs‚í‚ê‚Ä‚«‚œD“î•”ŽîᇂɊւ”‚ẮC1985 ”N‚æ‚è“o˜^‚ȘŠJŽn‚ł‚ê‚Ä‚ą‚éD‚±‚ê‚Í‘S‘‚̍œE“î•”Žîᇐf—ĂŽ{ĘiźŒ`ŠO‰Èj‚©‚ç”N1 ‰ń“o˜^‚ł‚ê‚œƒf[ƒ^‚Ć‚ ‚éD2007 ”N‚܂Ƃ́C“î•”ŽîᇂɊւ”‚Ă͈««Žîá‡‚Ì‚Ę‚Ì“o˜^‚Ć‚ ‚Á‚œ‚ȘC2008 ”N‚©‚ç‚͗ǐ«“î•”Žîᇂɂ‚ą‚Ä‚à“o˜^‚ȘŽn‚Ü‚Á‚œD‚œ‚Ÿ‚”C‚±‚Ì“o˜^‚đ—˜—p‚·‚éă‚Ƃ́CŠî–{“I‚ɐźŒ`ŠO‰È’P‰È‚Ć‚Ì“o˜^‚Ć‚ ‚邱‚ƁC‘S‘‚̍œE“î•”Žîᇐf—ĂŽ{Ę‚Ì‘S‚Ä‚Ș“o˜^‚”‚Ä‚ą‚é‚í‚Ż‚Ć‚Í‚È‚ą‚±‚ƁCŽèpÇ—á‚Ș7 Š„‚đè‚ß‚éƒf[ƒ^‚Ć‚ ‚邱‚ƂȂǁC•Î‚è‚Ì‚ ‚éƒf[ƒ^‚Ć‚ ‚邱‚Æ‚đ”FŽŻ‚”‚Ä‚š‚­•K—v‚Ș‚ ‚éD

–{Í‚Ƃ́C‰ą•Ä‚Ì•¶ŒŁ‚Æ‚Æ‚à‚É‚í‚Ș‘‚Ì‘S‘œE“î•”Žîᇓo˜^‚̃f[ƒ^‚đ‰đÍ‚”‚Ä‹LÚ‚”‚œD


CQ 1
—ǐ«Eˆ««‚ÌŠ„‡‚Í
—v–ń
Grade A
 
—ǐ«“î•”ŽîᇂƓ“śŽî‚Ì•p“x‚ÉŠÖ‚·‚鐳Šm‚ȃf[ƒ^‚Í‘¶Ę‚”‚È‚ą‚ȘC—ǐ«“î•”Žîᇂ̕û‚Ș‘œ‚ą‚Æ‚ą‚€ƒGƒrƒfƒ“ƒX‚Í‘¶Ę‚·‚éD
y‰đ@àz

•Ä‘‚Ì“Œv‚Ƃ͗ǐ«“î•”ŽîᇂƓ“śŽî‚Ì•p“x‚Í–ń100F1 ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2R00001jD‚œ‚Ÿ‚”C‚±‚ê‚Í•a‰@‚đŽóf‚”‚œŠłŽÒ‚Ì•p“x‚Ć‚ ‚èCŽÀÛ‚É‚Í•a‰@‚đŽóf‚”‚Ä‚ą‚È‚ą—ǐ«ŽîᇊłŽÒ‚Ș‘œ”‘¶Ę‚·‚é‚ƍl‚Š‚ç‚ê‚é‚œ‚߁C—ǐ«‚Ì•p“x‚Í‚ł‚ç‚ɍ‚‚ą‚ƍl‚Š‚ç‚ê‚éD

Armed Forces Institute of Pathology ‚ƁC1980 `1989 ”N‚Ü‚Ć‚Ì10 ”NŠÔ‚É•a—f’f‚đŽó‚Ż‚œ31,047 Œ‚ÌŠÔ—tŒnŽîᇂ̐f’f‚Ì“à–ó‚́C—ǐ«18,677 •a•Ï‚ɑ΂”‚Ĉ««‚Í12,370 •a•Ï‚Ć‚ ‚Á‚œ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F02708CEV level ⅤjD

‚í‚Ș‘‚Ì2008 ”N“x‘S‘œE“î•”Žîᇓo˜^‚Ƃ́C—ǁEˆ««“î•”Žîᇌv3,708 —á‚Ș“o˜^‚ł‚ê‚Ä‚š‚èC‚»‚Ì‚€‚żC—ǐ«‚Í70.4“Cˆ««‚Í29.6% ‚Ć‚ ‚Á‚œiT2R00005jD—ǐ«“î•”ŽîᇂƂ͎Ą—Ă‚đs‚í‚ž‚ÉŒo‰ßŠÏŽ@‚Șs‚í‚ê‚Ä‚ą‚é—á‚Ș‘œ‚­C•a‰@‚ƐfŽ@‚đŽó‚Ż‚Ä‚ą‚È‚ąŠłŽÒ‚Ì‘¶Ę‚àl—¶‚·‚é‚ƁC—ǐ«“î•”Žîᇂ̕p“x‚Í‚ł‚ç‚ɍ‚‚ą‚ƍl‚Š‚ç‚ê‚éD

‚ą‚ž‚ê‚Ì•ń‚Ć‚àˆ««Žîᇂɔ䂦‚ėǐ«Žîᇂ̕p“x‚͍‚‚­C“î•”Žîᇂɂš‚ą‚Ă͗ǐ«Žîᇂ̕û‚Șˆ««Žîᇂɔ䂦‚Ä‚©‚È‚è‘œ‚ą‚ƍl‚Š‚ç‚ê‚éD

y•¶@ŒŁz
1j T2R00001
Fletcher CD, Unni KK, Mertens FFWHO Classification of Tumours, Volume 5. Pathology and Genetics of Tumours of Soft Tissue and Bone, 3rd ed, IARC Press, LyonG2002
2j T2F02708
Kransdorf MJFMalignant soft-tissue tumors in a large referral populationF distribution of diagnoses by age, sex, and location. Am J Roentgenol 1995G 164i1jF129-134mEV level Ⅴn
3j T2R00005
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2008

CQ 2
”N—î‚ÆŽîᇂ̊֌W‚Í
—v–ń
Grade B
 
”N—îi”N‘ăj‚Č‚Æ‚É”­¶‚·‚é“î•”Žîᇂ̕p“xEŽí—Ț‚͈قȂéDŠeŽîᇂ̍D”­”N—î‚đ’m‚Á‚Ä‚š‚­‚±‚Æ‚Í“î•”Žîᇂ̊ӕʐf’f‚đi‚ß‚éă‚Ć—L—p‚Ć‚ ‚éD
y‰đ@àz

Armed Forces Institute of Pathology ‚©‚ç‚Ì•ń‚Ƃ́C“î•”“śŽî‚Ì’†‚ƁC0 `5 Î‚Ƃ͐üˆÛ“śŽîC6 `15 Î‚š‚æ‚Ń16 `25 Î‚Ć‚ÍŠŠ–Œ“śŽî‚ȘĆ‚à‘œ‚­C26 ÎˆÈă‚ÌŠe”N‘ă‚Ć‚Íˆ««üˆÛ«‘gD‹…Žî‚ȘĆ‚à‘œ‚ąiT2F02708CEV level ⅤjD

ˆê•ûCCheung ‚ç‚Ì•ń‚Ƃ́C19 ÎˆÈ‰ș‚̏ŹŽ™‚É”­¶‚·‚é“î•”“śŽî‚Ƃ͉Ą–ä‹Ű“śŽî‚Ș–ń”Œ”‚đè‚ß‚é‚ȘCŽlŽˆ”­¶—á‚ÉŒÀ’è‚·‚é‚ƁC“î•”“śŽî1,175 —á‚Ì‚€‚żCŠŠ–Œ“śŽî‚Ș225 —ái19.1“j‚ÆĆ‚à‘œ‚­C‰Ą–ä‹Ű“śŽî220 —ái18.7“jCüˆÛ“śŽî92 —ái7.8“j‚̏‡‚É‘œ‚ą‚Æ‚ł‚ê‚Ä‚ą‚éiT2F12421CEV level ⅤjD

‚í‚Ș‘‚Ì2008 ”N“x‘S‘œE“î•”Žîᇓo˜^ˆê——•\‚É‚æ‚é‚ƁC”N—î‚Æ‚Æ‚à‚É“î•”Žîᇂ̓o˜^”‚Í‘‰Á‚”C‚»‚̃s[ƒN‚Í60 `69 Î‚É‘¶Ę‚·‚ém}1iT2R00005jnDŽć‚È“î•”Žîᇂ̔N—î•Ê“o˜^”‚đ}2iT2R00005j‚ÉŽŠ‚·D40 ÎˆÈ‰ș‚ÌŽá”NŽÒ‚Ì“o˜^”‚Ș‘œ‚ąŽîᇂƂ”‚ėǐ«ŽîᇂƂ͌ŒŠÇŽîCˆ««ŽîᇂƂ͊Š–Œ“śŽî‚Ș‚ ‚°‚ç‚ê‚éD

}1 “î•”Žîᇂ̔N—î•Ê“o˜^”

}1 “î•”Žîᇂ̔N—î•Ê“o˜^”
‰ĄŽČF”N—î@cŽČF“o˜^Ç—ᐔ@‘“o˜^”3,708 —á

i‘S‘œE“î•”Žîᇓo˜^ˆê——•\2008j

}2 Žć‚È“î•”Žîᇁ–‚Ì”N—î•Ê“o˜^””

}2 Žć‚È“î•”Žîᇁ–‚Ì”N—î•Ê“o˜^”
–F2008 ”N“x‚Ì‘S‘“o˜^”‚Ș—ǐ«ŽîᇂƂÍ100 —áˆÈăCˆ««ŽîᇂƂÍ50 —áˆÈă‚Ì‚à‚́D
‰ĄŽČF”N—î@cŽČF“o˜^Ç—á

i‘S‘œE“î•”Žîᇓo˜^ˆê——•\2008j

y•¶@ŒŁz
1j T2F02708
Kransdorf MJFMalignant soft-tissue tumors in a large referral populationF distribution of diagnoses by age, sex, and location. Am J Roentgenol 1995G 164F129-134@mEV level Ⅴn
2j T2F12421
Cheung MC, Zhuge Y, Yang R et alFIncidence and outcomes of extremity soft-tissue sarcomas in children. J Surg Res 2010G163i2jF282-289@mEV level Ⅴn
3j T2R00005
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2008

CQ 3
«•Ê‚Í
—v–ń
Grade B
“î•”“śŽî‚Í‚â‚â’j«‚É‘œ‚ąŒXŒü‚Ș‚ ‚éD
y‰đ@àz

Saithna ‚ç‚É‚æ‚é‰p‘‚©‚ç‚Ì1,508 —á‚Ì“î•”“śŽî‚Ì•ń‚Ƃ́C«·‚Í1.4F1 ‚Ć’j«‚É‘œ‚ąiT2F01066CEV level ⅤjD

‚Ü‚œCGustafson ‚É‚æ‚éƒXƒEƒF[ƒfƒ“‚©‚ç‚Ì16 ÎˆÈă‚Ì“î•”“śŽî508 —á‚Ì•ń‚Ƃ́C’j«288 —áC—«220 —á‚Ć‚ ‚éiTF01239CEV level ⅤjD

‚í‚Ș‘‚Ì‘S‘“î•”Žîᇓo˜^ˆê——•\‚É‚æ‚é‚ƁC2006 `2008 ”N‚É“o˜^‚ł‚ê‚œ“î•”“śŽî‚Ì‚€‚żC’j«‚Í1,747 —áC—«‚Í1,464 —á‚Ć‚ ‚éiT2R00005jD

‚±‚ê‚ç‚ą‚ž‚ê‚Ì•ń‚É‚š‚ą‚Ä‚àC“î•”“śŽî‚Í’j«‚É‚â‚â‘œ‚ąŒXŒü‚Ș”F‚ß‚ç‚ê‚éD

y•¶@ŒŁz
1j T2F01066
Saithna A, Pynsent PB, Grimer RJFRetrospective analysis of the impact of symptom duration on prognosis in soft tissue sarcoma. Int Orthop 2008G32 i3jF381-384.@mEV level Ⅴn
2j TF01239
Gustafson PFSoft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 1994G259F1-31@mEV level Ⅴn
3j T2R00005
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2008

CQ 4
”­¶•”ˆÊ‚Í
—v–ń
Grade B
 
‰^“źŠí‚É”­¶‚·‚é“î•”“śŽî‚͉șŽˆ‚É‘œ‚ąD‚Ü‚œC“î•”Žîᇂ̒†‚É‚Í‘gDŒ^‚É‚æ‚Á‚čD”­•”ˆÊ‚đ—L‚·‚éŽîᇂȘ‘¶Ę‚·‚éD
y‰đ@àz

“î•”“śŽî‚́C‘ć‘ڂȂljșŽˆ‚É”­¶‚·‚é•p“x‚Ș‚‚ąD

“Á’„“I‚ȍD”­•”ˆÊ‚đŽŠ‚·“î•”ŽîᇂƂ”‚Ă͈ȉș‚Ì‚æ‚€‚È‚à‚Ì‚Ș‚ ‚°‚ç‚ê‚éD

  • äFâ‹Ś–EŽî‚ÍŽèC“Á‚Ɏ菶‘€C‹ü‹ŰäFäFâ‚Ì”­¶‚Ș‘œ‚ąiTF00167CEV level Ⅴj
  • F‘f«ăO–ŃŒ‹ß«ŠŠ–Œ‰Š^‚Ń‚Ü‚ńŒ^‹Ś–EŽî‚Í•GŠÖß‚É‘œ‚ąiTF00493CEV level Ⅴj
  • ’e«üˆÛŽî‚Í”w•”ŒšbœŽüˆÍ‚É‘œ‚ąiTF00194CEV level Ⅴj
  • ƒOƒƒ€ƒXŽîᇂ͎èŽw––œC“Á‚ɒ܉ș‚É‘œ‚ąiTF00216CEV level Ⅴj
  • —Ță”ç“śŽî‚Í‘O˜r‚©‚çŽè‚̐ó‘w‚É‘œ‚ąiT2F02257CEV level Ⅴj

Gustafson ‚É‚æ‚é“î•”“śŽî508 —á‚Ì•ń‚Ƃ́C”­¶•”ˆÊ‚͉șŽˆ318 —ái62.6“jCăŽˆ122 —ái24.0“jC‘ÌŠČ68 —ái13.4“j‚Ć‚ ‚éiTF01239CEV level ⅤjD

ˆê•ûCEnzinger and Weiss ‚Ì‹ł‰È‘‚É‹LÚ‚ł‚ê‚œM.D.Anderson Cancer Center Sarcoma Database ‚É‚æ‚é‚ƁC“î•”“śŽî‚Ì”­¶•”ˆÊ‚́C‰șŽˆ26“CŒă• –ŒE• o“à25“C“à‘ŸiGIST ‚àŠÜ‚Țj25“CăŽˆ11“C‹čŠs8“C“ȘŒz•”5“C‚Æ‚ł‚ê‚Ä‚ą‚éiT2R00002jD

‚í‚Ș‘‚̐źŒ`ŠO‰ÈE•a—ˆ««“î•”Žîᇎ戔‚ą‹K–ńi2002 ”Nj‚Ƃ́C‰șŽˆ66.7“CăŽˆ19.5“C‘ÌŠČ11.3“C“ȘŒz•”1.8“‚Ì”­¶—Š‚Æ‹LÚ‚ł‚ê‚Ä‚ą‚éiT2R00006jD

‚Ü‚œC‘S‘œE“î•”Žîᇓo˜^ˆê——•\‚É‚æ‚é‚ƁC2006 `2008 ”N‚É“o˜^‚ł‚ê‚œ“î•”Žîá‡5,948 —ái—ǁEˆ««ŠÜ‚Țj‚Ì”­¶•”ˆÊ‚́C‰șŽˆ2,578 —ái43.3%jCăŽˆ1,490 —ái25.0%jC‘ÌŠČ1,219 —ái20.5%jCŒă• –Œ207 —ái3.5%jC“ȘŒz•”248 —ái4.2%jC‘œ”­206 —ái3.5%j‚Ć‚ ‚éiT2R00005CEV leveljD

y•¶@ŒŁz
1j TF00167
Peh WC, Wong Y, Shek TW et alFGiant cell tumour of the tendon sheath of the handFa pictorial essay. Australas Radiol 2001G45i3jF274-280@mEV level Ⅴn
2j TF00493
de Visser E, Veth RP, Pruszczynski M et alFDiffuse and localized pigmented villonodular synovitisFevaluation of treatment of 38 patients. Arch Orthop Trauma Surg 1999G119F401-404@mEV level Ⅴn
3j TF00194
Majo J, Gracia I, Doncel A et alFElastofibroma dorsi as a cause of shoulder pain or snapping scapula. Clin Orthop 2001 388F200-204@mEV level Ⅴn
4j TF00216
Takata H, Ikuta Y, Ishida O et alFTreatment of subungual glomus tumour. Hand Surg 2001G6i1jF25-27@mEV level Ⅴn
5j T2F02257
Rekhi B, Gorad BD, Chinoy RFFClinicopathological features with outcomes of a series of conventional and proximal-type epithelioid sarcomas, diagnosed over a period of 10 years at a tertiary cancer hospital in India. Virchows Arch 2008G453i2jF141-153@mEV level Ⅴn
6j T2R00002
Weiss SW, Goldblum JRFEnzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008
7j T2R00006
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ïi•ÒjFźŒ`ŠO‰ÈE•a—ˆ««“î•”Žîᇎ戔‚ą‹K–ń ‘æ3 ”ƁC‹àŒŽo”ƁC“Œ‹žG2002
8j T2R00005
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2008
9j TF01239
Gustafson PFSoft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 1994G259F1-31@mEV level Ⅴn

CQ 5
‘gDŒ^‚Æ•p“x‚Í
—v–ń
Grade B
 
‘S‘œE“î•”Žîᇓo˜^ˆê——•\‚É‚æ‚é‚ƁC—ǐ«“î•”ŽîᇂƂ͎‰–bŽîC_ŒoâŽîCŒŒŠÇŽî‚Ș‘œ‚ąD“î•”“śŽî‚Ć‚ÍŽ‰–b“śŽîCˆ««üˆÛ«‘gD‹…ŽîC•œŠŠ‹Ű“śŽî‚Ș‘œ‚ąD
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—ǐ«“î•”Žîᇂ̐łŠm‚È”­¶•p“x‚Ì•ń‚Ș‚È‚ą‚Ì‚Í‘Oq‚Ì‚Æ‚š‚è‚Ć‚ ‚é‚ȘCŽ‰–bŽî‚ÆŒŒŠÇŽî‚Ì•p“x‚͍‚‚ąmiT2F01195jCiT2F00622CEV level ⅤjnDArmed Forces Institute of Pathology ‚Ć•a—f’f‚đŽó‚Ż‚œ18,677 —á‚̗ǐ«ŠÔ—tŒn•a•Ïi_Œo«Žîᇂ͏œ‚­j‚Ì’†‚Ƃ́CŽ‰–bŽî‚Ș16“‚ÆĆ‚à‘œ‚­C—ǐ«üˆÛ«‘gD‹…Žîi”畆üˆÛŽî‚àŠÜ‚Țj13“CŒ‹ß«‹Ű–Œ‰Š11“CŒŒŠÇŽî8“‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F12423CEV level ⅣjD‘S‘œE“î•”Žîᇓo˜^ˆê——•\‚Ć•p“x‚Ș‚‚ą—ǐ«“î•”Žîᇂ́CŽ‰–bŽîC_ŒoâŽîCŒŒŠÇŽî‚Ć‚ ‚éi•\1jiT2R00005jD

Armed Forces Institute of Pathology ‚Ć•a—f’f‚ł‚ê‚œ12,370 —á‚Ì“î•”“śŽî‚Ì“à–ó‚́C•p“x‚̍‚‚ą‡‚ɁCˆ««üˆÛ«‘gD‹…Žî24“CŽ‰–b“śŽî14“C•œŠŠ‹Ű“śŽî8“Cˆ««––œ_ŒoâŽîá‡6“‚Ć‚ ‚Á‚œ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F02708CEV level ⅤjDźŒ`ŠO‰ÈE•a—“î•”“śŽîŽæˆ”‚ą‹K–ń‚É‚æ‚é‚ƁC1985 `1994 ”N‚Ì‚í‚Ș‘‚É‚š‚Ż‚é“î•”“śŽî‚Ì‘gDŒ^‚́C•p“x‚̍‚‚ą‡‚ɁCˆ««üˆÛ«‘gD‹…ŽîCŽ‰–b“śŽîCŠŠ–Œ“śŽîC‰Ą–ä‹Ű“śŽîCˆ««––œ_ŒoâŽîᇁC•œŠŠ‹Ű“śŽî‚Ć‚ ‚Á‚œ‚Æ‚ł‚ê‚Ä‚ą‚éiT2R00006jD‘S‘“î•”Žîᇓo˜^ˆê——•\‚Ƃ́C“î•”“śŽî‚Ì‚€‚żCŽ‰–b“śŽî‚Ș324 —á‚ÆĆ‚à‘œ‚­Cˆ««üˆÛ«‘gD‹…Žî233 —áC•œŠŠ‹Ű“śŽî92 —áCŠŠ–Œ“śŽî64 —á‚Æ‘±‚­i•\1jiT2R00005jD

‰ß‹Ž‚Ì•ń‚ƁC2008 ”N‚Ì‘S‘“î•”Žîᇓo˜^ˆê——•\‚É‚š‚Ż‚é“î•”“śŽî‚Ì”­¶•p“x‚É‚Íˆá‚ą‚Ș‚Ę‚ç‚ê‚éD‚±‚ê‚́C2002 ”N‚É“î•”ŽîᇂÌWHO •Ș—Ț‚Ș‰ü’è‚ł‚êCˆ««üˆÛ«‘gD‹…Žî‚ȘÄ•Ș—Ți”S‰tüˆÛ“śŽî‚È‚Ç‚Șˆ««üˆÛ«‘gD‹…Žî‚̐f’f‚©‚ç•Ș—Ł‚ł‚êCˆ««üˆÛ«‘gD‹…Žî‚Í‘Œ‚ÌŽîᇂɕȘ—Ț‚Ć‚«‚È‚ą–ą•Ș‰»‘œŒ`“śŽî‚Æ’è‹`j‚ł‚ê‚œ‚±‚Æ‚É‚æ‚é‰e‹ż‚Ș‘ć‚«‚ą‚ƍl‚Š‚ç‚ê‚éiT2R00001jD

•\1 ‘S‘œE“î•”Žîᇓo˜^ˆê——•\‚É‚š‚ą‚Ä•p“x‚̍‚‚ą“î•”Žîá‡
—ǐ«“î•”Žîᇠ“o˜^” “î•”“śŽî “o˜^”
1

Ž‰–bŽî

850 1

Ž‰–b“śŽî

324
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_ŒoâŽî

470 2

ˆ««üˆÛ«‘gD‹…Žî

233
3

ŒŒŠÇŽî

269 3

•œŠŠ‹Ű“śŽî

92
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1j T2F01195
Billing V, Mertens F, Domanski HA et alFDeep-seated ordinary and atypical lipomasFhistopathology, cytogenetics, clinical features, and outcome in 215 tumours of the extremity and trunk wall. J Bone Joint Surg Br 2008G90i7jF 929-933
2j T2F00622
Tang P, Hornicek FJ, Gebhardt MC et alFSurgical treatment of hemangiomas of soft tissue. Clin Orthop Relat Res 2002G399F205-210@mEV level Ⅴn
3j T2F12423
Kransdorf MJFBenign soft-tissue tumors in a large referral populationF distribution of specific diagnoses by age, sex, and location. Am J Roentgenol 1995G164i2jF395-402@mEV Level Ⅳn
4j T2R00005
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2008
5j T2F02708
Kransdorf MJFMalignant soft-tissue tumors in a large referral populationF distribution of diagnoses by age, sex, and location. Am J Roentgenol 1995G 164i1jF129-134@mEV level Ⅴn
6j T2R00006
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ïi•ÒjFźŒ`ŠO‰ÈE•a—ˆ««“î•”Žîᇎ戔‚ą‹K–ń ‘æ3 ”ƁC‹àŒŽo”ƁC“Œ‹žG2002
7j T2R00001
Fletcher CD, Unni KK, Mertens FFWHO Classification of Tumours, Volume 5. Pathology and Genetics of Tumours of Soft Tissue and Bone, 3rd ed, IARC Press, LyonG2002

CQ 6
‘Œ‚ÌŽŸŠł‚⎥—Ă‚É‡•č„‘±”­‚·‚éŽîᇂ?/th>
—v–ń
Grade B
•p“x‚Í’á‚ą‚ȘC“]ˆÚ«“î•”ŽîᇂƁC•úŽËüŽĄ—Ă‚âƒŠƒ“ƒp•‚Žî‚É‘±”­‚·‚é“î•”ŽîᇂȘ‚ ‚éD
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‘ć‘œ”‚Ì“î•”Žîᇂɂš‚ą‚ẮC‚»‚Ì”­¶ŒŽˆö‚Í•s–Ÿ‚Ć‚ ‚éD‚”‚©‚”C‚Ü‚ê‚É“]ˆÚ«‚Ì“î•”ŽîᇂâC•úŽËüÆŽË‚È‚Ç‚ÌŽĄ—ÁC–«ƒŠƒ“ƒp•‚Žî‚Ȃǂ̐æs‚·‚é•a‘Ô‚É‘±”­‚·‚é“î•”ŽîᇂȘ”F‚ß‚ç‚ê‚éD

“]ˆÚ«œŽîᇂɔ䂦C“]ˆÚ«“î•”Žîᇂ͂܂ê‚Ć‚ ‚éDPlaza ‚ç‚́C“î•”Žîá‡7,237 —á‚Ì‚€‚ż118 —ái1.6“j‚Ș“]ˆÚ«“î•”ŽîᇂƂ ‚èC‚»‚Ì‚€‚ż70“‚ȘŠàŽî‚Ì“]ˆÚ‚ĆŒŽŽŸŠł‚Í”xŠàCtŠàC‘ć’°Šà‚̏‡‚Ć‚ ‚Á‚œ‚Æ•ń‚”‚Ä‚ą‚éiT2F12420CEV level ⅤjD

•úŽËüÆŽËŒă‚ɁCÆŽË–ì‚©‚ç“ńŽŸ«‚É“î•”“śŽî‚Ș”­¶‚·‚邱‚Æ‚Ș’m‚ç‚ê‚Ä‚ą‚éDPenel ‚ç‚́CŹl‚Ì“î•”“śŽî658 —á‚Ì‚€‚żC22 —ái3.3“j‚Ș•úŽËüŽĄ—ĂŒă–ń10 ”Ni3`45 ”Nj‚Ć”­Ç‚”‚œ“ńŽŸ«“î•”“śŽî‚Ć‚ ‚èCŒŽŽŸŠł‚Í10 —á‚Ș“ûŠàC4 —á‚Ș”ńƒzƒWƒLƒ“ƒŠƒ“ƒpŽî‚Ć‚ ‚Á‚œ‚Æ•ń‚”‚Ä‚ą‚éiT2F12419CEV level ⅤjD‚í‚Ș‘‚©‚ç‚Ì•úŽËüÆŽËŒă“î•”“śŽî14 —á‚ÌŒŸ“ą‚Ƃ́C•œ‹Ï62 Gy ‚Ì•úŽËüÆŽËŒăC•œ‹Ï12.6 ”N‚Ć“ńŽŸ«“î•”“śŽî‚Ș”­¶‚”C•a—Šw“I‚ɂ͈««üˆÛ«‘gD‹…Žî8 —áCœŠO«œ“śŽî4 —áC•œŠŠ‹Ű“śŽî1 —áCüˆÛ“śŽî1 —á‚Ć‚ ‚Á‚œ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F01533CEV level ⅤjD

“ûŠàȘŽĄp‚̃Šƒ“ƒpßŠsŽpŒă‚ÌăŽˆ‚âCŽq‹{èòŠàpŒă‚̉șŽˆ‚É–«ƒŠƒ“ƒp•‚Žî‚𐶂¶‚邱‚Æ‚Í‚æ‚­’m‚ç‚ê‚Ä‚ą‚éD‚±‚Ì–«ƒŠƒ“ƒp•‚Žî‚ÉŒŒŠÇ“śŽî‚Ș‘±”­‚·‚邱‚Æ‚Ș‚ ‚èCStewart-Treves ÇŒóŒQ‚ƌĂ΂ê‚éiT2F12419CEV level ⅤjD

y•¶@ŒŁz
1j T2F12420
Plaza JA, Perez-Montiel D, Mayerson J et alFMetastases to soft tissueFa review of 118 cases over a 30-year period. Cancer 2008G112i1jF193-203@mEV level Ⅴn
2j T2F12419
Penel N, Grosjean J, Robin YM et alFFrequency of certain established risk factors in soft tissue sarcomas in adultsFa prospective descriptive study of 658 cases. Sarcoma 2008G2008F459386@mEV level Ⅴn
3j T2F01533
Fang Z, Matsumoto S, Ae K et alFPostradiation soft tissue sarcomaFa multiinstitutional analysis of 14 cases in Japan. J Orthop Sci 2004G9i3jF 242-246@mEV level Ⅴn

CQ 7
ˆâ“`«E‰Æ‘°«‚Ì‚ ‚éŽîᇂÍ
—v–ń
Grade B
 
 
ˆâ“`«E‰Æ‘°«‚Ș”F‚ß‚ç‚ê‚é“î•”ŽîᇂƂ”‚ẮC_ŒoüˆÛŽîÇi1 Œ^C2 Œ^jC–Ô–Œ‰èŚ–EŽî‚É‘±”­‚·‚éŽîᇁCGardneriƒK[ƒhƒi[jÇŒóŒQ‚É‚š‚Ż‚éƒfƒXƒ‚ƒCƒhCLi-FraumeniiƒŠEƒtƒ‰ƒEƒƒjjÇŒóŒQ‚ɐ¶‚¶‚é“î•”ŽîᇂȂǂȘ‚ ‚éD
y‰đ@àz

“î•”“śŽî‚Ì”­¶•p“x‚Í’á‚­C‚Ù‚Æ‚ń‚Ç‚ÌŽîᇂƔ­¶ŒŽˆö‚Í•s–Ÿ‚Ć‚ ‚éD‚”‚©‚”C‚Ü‚ê‚Ć‚Í‚ ‚é‚Șˆâ“`Šw“I‘fˆö‚Ș”F‚ß‚ç‚ê‚éŽîá‡‚à‘¶Ę‚·‚éDˆâ“`«E‰Æ‘°«‚É“î•”ŽîᇂȘ¶‚¶‚鎟Šł‚Æ‚”‚āC_ŒoüˆÛŽîÇi1 Œ^C2 Œ^jCˆâ“`«–Ô–Œ‰èŚ–EŽîCGardner ÇŒóŒQC‚š‚æ‚ŃLi-Fraumeni ÇŒóŒQ‚Ș’m‚ç‚ê‚Ä‚ą‚éD

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  • ƒtƒ‰ƒ“ƒX‚©‚ç‚Ì“î•”“śŽî658 —á‚Ì•ń‚Ƃ́C19 —ái2.8“j‚Ɉâ“`«‚Ș”F‚ß‚ç‚êC‚»‚Ì‚€‚ż_ŒoüˆÛŽîÇ‚Ș14 —áC—Œ‘€«–Ô–Œ‰èŚ–EŽî‚Ș2 —á‚Ć‚ ‚Á‚œ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F12419CEV level ⅤjD
  • _ŒoüˆÛŽîÇ‚Ì’†‚Ƃ͐_ŒoüˆÛŽîÇ1 Œ^iNF1j‚Ș‘œ‚ąDNF1 ‚Ƃ͐_ŒoüˆÛŽîCƒJƒtƒFƒIƒŒ”Á‚Ȃǂ̔畆Çó‚Ș‚•p“x‚ÉŒ©‚ç‚ê‚éDŒŽˆöˆâ“`Žq‚Í17 ”ԐőF‘Ì‚É‘¶Ę‚·‚éNF1 ˆâ“`ŽqŽY•šneurofibromin ‚Ć‚ ‚éDƒhƒCƒc‚É‚š‚Ż‚錀‹†‚Ć‚Í”­¶•p“x‚͐lŒû–ń3,000 l‚É1 l‚ÌŠ„‡‚Ć‚ ‚èC”Œ”‚ȘíőF‘Ì—D«ˆâ“`Œ`Žź‚đ‚Æ‚èCŽc‚è‚Í“Ë‘R•ÏˆÙ‚É‚æ‚éŒÇ”­—á‚Ć‚ ‚éiT2F12417CEV level ⅣjDNF1 ‚Ɉ««––œ_ŒoâŽîᇂȘ‡•č‚·‚邱‚Æ‚Ș’m‚ç‚ê‚Ä‚ą‚éiT2F12418CEV level ⅣjD
  • _ŒoüˆÛŽîÇ2 Œ^iNF2j‚Í—Œ‘€’ź_ŒoâŽî‚đ“Á’„‚Æ‚”CŽlŽˆ‚É‚à_ŒoâŽî‚đD”­‚·‚é‚Ș”畆•a•Ï‚͏­‚È‚ąDŒŽˆöˆâ“`Žq‚Í22 ”ԐőF‘Ì‚É‘¶Ę‚·‚éNF2 ˆâ“`ŽqŽY•šmerlin/schwannomin ‚Ć‚ ‚éD‰p‘‚Ƃ́CNF2 ‚Ìœë•a—Š‚͏o¶33,000 `40,000 l‚ ‚œ‚è1 l‚Ć‚ ‚èC”Œ”‚ȘíőF‘Ì—D«ˆâ“`‚Ć‚ ‚èCŽc‚è‚͈â“`Žq“Ë‘R•ÏˆÙ‚Ć‚ ‚éiT2F12415CEV level ⅣjD
  • –Ô–Œ‰èŚ–EŽî‚͏ŹŽ™‚É”­Ç‚·‚éŠá‚̈««ŽîᇂƂ ‚èC“Żˆê‰Æ‘°“à‚É•Ą”‚Ì”­ÇŽÒ‚đ”F‚ß‚éê‡‚ɁCˆâ“`«–Ô–Œ‰èŚ–EŽî‚ÆŒÄ‚ŃC‘S–Ô–Œ‰èŚ–EŽî‚Ì–ń10“‚đè‚ß‚éDŒŽˆöˆâ“`Žq‚Í13 ”ԐőF‘Ì‚É‘¶Ę‚·‚é‚Ș‚ń—}§ˆâ“`ŽqRB1 ˆâ“`Žq‚Ć‚ ‚éDˆâ“`«–Ô–Œ‰èŚ–EŽî‚ÌŠłŽÒ‚́C–Ô–Œ‰èŚ–EŽîˆÈŠO‚ɍœ“śŽîC“î•”“śŽîCˆ««•FŽî‚Ȃǂ̈««Žîᇂ𔭏ǂ·‚éD•Ä‘‚©‚ç‚Ì•ń‚Ƃ́Cˆâ“`«–Ô–Œ‰èŚ–EŽî963 —á‚Ì‚€‚ż68 Ç—á‚É69 —á‚Ì“î•”“śŽî‚Ș”­¶‚”C‘gDŒ^‚Í•œŠŠ‹Ű“śŽî22 —áCüˆÛ“śŽî13 —áCˆ««üˆÛ«‘gD‹…Žî12 —á‚È‚Ç‚Ć‚ ‚Á‚œ‚Æ‚ł‚ê‚Ä‚ą‚éiT2F08929CEV level ⅤjD
  • Gardner ÇŒóŒQ‚͉Ƒ°«‘ć’°‘BŽîÇi‰Æ‘°«‘ć’°ƒ|ƒŠƒ|[ƒVƒXFFAPj‚É“ȘŠWœ‚â’·ŠÇœ‚̍œŽî‚â“î•”ŽîᇂȘ‡•č‚”‚œ‚à‚Ì‚Ć‚ ‚éDFAP ‚ÌŒŽˆöˆâ“`Žq‚Í5 ”ԐőF‘Ì‚É‘¶Ę‚·‚éAPC ˆâ“`Žq‚Ć‚ ‚èCAPC ˆâ“`Žq‚̐¶BŚ–E•ÏˆÙ‚É‚æ‚éíőF‘Ì—D«ˆâ“`‚Ć‚ ‚éDFAP ‚Ì12“‚ɃfƒXƒ‚ƒCƒh‚Ș‡•č‚”CŽć‚É• •Ç‚â• o“à‚É”­¶‚·‚éiT2F12422CEV level ⅠjD
  • Li-FraumeniÇŒóŒQ‚́C”ńí‚É‚Ü‚ê‚ȉƑ°«ŽîᇏnjóŒQ‚Ć‚ ‚èCąŠE‚Ć‚Ì•ń‚Í400 ‰ÆŒn‚É–ž‚œ‚È‚ąDŽíX‚ÌŠà‚𐶂¶‚郊ƒXƒN‚đ—L‚”C50“ˆÈă‚ÌŠłŽÒ‚ÍŒŽˆöˆâ“`Žq‚ÌTP53 ‚ɕψقȘŠm”F‚ł‚ê‚éDíőF‘Ì—D«ˆâ“`‚ÌŒ`Žź‚đ‚Æ‚éD•Ä‘‚É‚š‚Ż‚éLi-Fraumeni ÇŒóŒQ24 ‰ÆŒn‚Ì’Čž‚Ƃ́C1,004 ŒŒ‘°’†200 —á‚ÉŠà‚Ș”­¶‚”C‚»‚Ì‚€‚ż34 —á‚Ș“î•”“śŽî‚Ć‚ ‚Á‚œ‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2F12416CEV level ⅤjD
y•¶@ŒŁz
1j T2F12419
Penel N, Grosjean J, Robin YM et alFFrequency of certain established risk factors in soft tissue sarcomas in adultsFa prospective descriptive study of 658 cases. Sarcoma 2008G2008F459386@mEV level Ⅴn
2j T2F12417
Lammert M, Friedman JM, Kluwe L et alFPrevalence of neurofibromatosis 1 in German children at elementary school enrollment. Arch Dermatol 2005G 141i1jF71-74@mEV Level Ⅳn
3j T2F12418
McCaughan JA, Holloway SM, Davidson R et alFFurther evidence of the increased risk for malignant peripheral nerve sheath tumour from a Scottish cohort of patients with neurofibromatosis type 1. J Med Genet 2007G44i7jF 463-466@mEV Level Ⅳn
4j T2F12415
Evans DG, Huson SM, Donnai D et alFA genetic study of type 2 neurofibromatosis in the United Kingdom. I. Prevalence, mutation rate, fitness, and confirmation of maternal transmission effect on severity. J Med Genet 1992G29i12jF841-846@mEV Level Ⅳn
5j T2F08929
Kleinerman RA, Tucker MA, Abramson DH et alFRisk of soft tissue sarcomas by individual subtype in survivors of hereditary retinoblastoma. J Natl Cancer Inst 2007G99i1jF24-31@mEV level Ⅴn
6j T2F12422
Sinha A, Tekkis PP, Gibbons DC et alFRisk factors predicting desmoid occurrence in patients with familial adenomatous polyposisFa meta-analysis. Colorectal Dis 2010FmEpub ahead of printn@mEV level Ⅰn
7j T2F12416
Hisada M, Garber JE, Fung CY et alFMultiple primary cancers in families with Li-Fraumeni syndrome. J Natl Cancer Inst 1998G90i8jF606-611@mEV level Ⅴn

‘æ‚RÍ@—Տ°Çó‚ÆŒŸžŠŒ©

Clinical QuestionE„§ˆê——‚Ö


CQ 1
–âfă‚Ì’ˆÓ“_‚Í
—v–ń
Grade C
–âfăd—v‚ȃ|ƒCƒ“ƒg‚ÍŽć‚É”­Ç‚ÌŽd•û‚Æ’É‚Ę‚Ì—L–ł‚Ć‚ ‚éD
y‰đ@àz

–âf‚É‚š‚ą‚Ä”­Ç‚ÌŽd•û‚Æ’É‚Ę‚Ì—L–ł‚đ•·‚­‚±‚Æ‚É‚æ‚èCŽîᎂȘˆ««‚©—ǐ«‚©”ńŽîᇐ«ŽŸŠł‚©„’è‰Â”\‚ȏꍇ‚Ș‚ ‚éD

–âf‚É‚š‚ą‚Ä‚Í‚Ü‚žŽîᇂ̑‘ć‘Ź“x‚đ’m‚é‚€‚Š‚ƁCŽîᇂɂą‚‹C‚Ă‚ą‚œ‚©C‚Ç‚Ì‚æ‚€‚É‚”‚Ä‹C‚Ă‚ą‚œ‚©C‚»‚ÌŒăfŽ@Žž‚Ü‚Ć‚É‘ć‚«‚­‚È‚Á‚œ‚Æ‚ą‚€Ž©Šo‚Ș‚ ‚é‚©‚Ç‚€‚©‚đ•·‚­D

—ǐ«Žîᇂ̑‘ć‘Ź“x‚Í”äŠr“I‚ä‚Á‚­‚è‚”‚Ä‚ą‚é‚à‚Ì‚Ș‘œ‚ą‚œ‚߁miTF00073CEV level ⅤjCiT2F00932CEV level ⅤjCiTF01149jCiT2F02141CEV level ⅤjnCáu’É‚âŽî᎐G’m‚Ȃǂ̏Ǐ󎝑±ŠúŠÔ‚͐””N’PˆÊ‚É‹y‚Ô‚Ì‚Șˆê”Ê“I‚Ć‚ ‚éDˆê•ûCˆ««Žîᇂ͌Ž’PˆÊ‚Ć‘ć‚«‚­‚È‚é‚Ì‚Ș’ʏí‚Ć‚ ‚éD‚Ü‚œ“Ë‘R‚ɏoŒ»‚”‚œŽîᎂâC‚ ‚é‚ą‚͐”“ú‚Ć‘ć‚«‚­‚È‚Á‚œŽîᎂƂ”‚ẮC”^ᇁC‹Ű“ś“àoŒŒCŒ‹ß«‹Ű–Œ‰Š‚ȘŠÓ•Êf’f‚Æ‚”‚Ä‚ ‚°‚ç‚ê‚éD‹Ű“ś“àoŒŒ‚Í”][ÇŒă‚È‚Ç‚ĆR‹ĂŒĆ—Ă–@–ò‚đ“à•ž‚”‚Ä‚ą‚銳ŽÒ‚ÉŒ©‚ç‚ê‚邱‚Æ‚Ș‘œ‚ą‚ȘC“à•ž‚”‚Ä‚ą‚È‚ąŠłŽÒ‚É‚à”F‚ß‚ç‚ê‚邱‚Æ‚Ș‚ ‚éD

‚œ‚Ÿ‚”Cˆ««ŽîᇂƂà‚Ü‚ê‚Ć‚Í‚ ‚é‚ȘCŠŠ–Œ“śŽîC—Ță”ç“śŽî‚È‚Ç‚Ć‚Í”N’PˆÊ‚Ć‘ć‚«‚­‚Ȃ邱‚Æ‚Ș‚ ‚émiT2F01196CEV level ⅤjCiT2F02257CEV level ⅤjnD‚”‚œ‚Ș‚Á‚āC”N’PˆÊ‚Ć‘ć‚«‚­‚È‚Á‚œ‚±‚Æ‚Ÿ‚Ż‚Ɨǐ«‚ÆŠm’è‚·‚é‚Ì‚ÍŠëŒŻ‚Ć‚ ‚éD‚ł‚ç‚ɗǐ«Žîᇂ̂Ȃ©‚Ć‚à_ŒoâŽîCŒŒŠÇŽî‚Ȃǂ͏oŒŒ‚·‚é‚Æ‹}‘Ź‚É‘ć‚«‚­‚Ȃ邱‚Æ‚Ș‚ ‚éD

áu’É‚Ì—L–ł‚Ì–âf‚à”ńí‚ɏd—v‚Ć‚ ‚èC–{ÍCQ6 ‚É‹LÚ‚ł‚ê‚Ä‚ą‚éD

‚»‚Ì‘ŒC–âfă’ˆÓ‚·‚é“_‚Æ‚”‚Ä‚ÍŽć‘i‚ÌŽîᎈȊO‚Ì•”ˆÊ‚ÉŽîᎂȘ‚È‚ą‚©‚Ç‚€‚©C‚·‚È‚í‚ż‘œ”­«‚ÌŽîᇂƂ ‚é‚©‚Ç‚€‚©‚đ–Y‚ê‚ž‚É‚«‚­‚±‚Æ‚Ć‚ ‚éi–{ÍCQ5 ŽQÆjD

ŠO‚Ì—L–ł‚ÉŠÖ‚”‚ẮCŽîᇂƊO‚Æ‚ÌŠÖ˜A‚͈ê”Ê‚É‚È‚ą‚Æ‚ł‚ê‚Ä‚ą‚éDŠO‚Æ‚ÌŠÖ˜A‚̉”\«‚Ș‚ ‚éŽîᎂƂ”‚Ă͍œ‰»«‹Ű‰Š‚Ș‚ ‚éiT2R00002jD

‰Æ‘°—đ‚à•·‚­‚Ś‚«‚Ć‚ ‚éD‚·‚È‚í‚ż‘œ”­«‚̐_ŒoüˆÛŽî‚∫«––œ_ŒoâŽîᇂƊ֘A‚̐[‚ą_ŒoüˆÛŽîÇ1 Œ^ivon Recklinghausen •aj‚Í‘œ‚­‚ȘíőF‘Ì—D«ˆâ“`‚Ć‚ ‚èC‰Æ‘°—đ‚Ì—L‚é–ł‚”‚Șƒ|ƒCƒ“ƒg‚Æ‚È‚éi‘æ2 ÍCQ7 ŽQÆjD

y•¶@ŒŁz
1j TF00073
Gibbons CL, Khwaja HA, Cole AS et alFGiant-cell tumour of the tendon sheath in the foot and ankle. J Bone Joint Surg Br 2002G84i7jF1000-1003@mEV level Ⅴn
2j T2F00932
Al-Qattan MM, Al-Lazzam AM, Al Thunayan A et alFClassification of benign fatty tumours of the upper limb. Hand Surg 2005G10i1jF43-59@mEV level Ⅴn
3j TF01149
Glowacki KA, Weiss APFGiant cell tumors of tendon sheath. Hand Clin 1995G11i2jF245-253
4j T2F02141
Griffin N, Khan N, Thomas JM et alFThe radiological manifestations of intramuscular haemangiomas in adultsFmagnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol 2007G36i11jF1051-1059@mEV level Ⅴn
5j T2F01196
Chotel F, Unnithan A, Chandrasekar CR et alFVariability in the presentation of synovial sarcoma in childrenFa plea for greater awareness. J Bone Joint Surg Br 2008G90i8jF1090-1096@mEV level Ⅴn
6j T2F02257
Rekhi B, Gorad BD, Chinoy RFFClinicopathological features with outcomes of a series of conventional and proximal-type epithelioid sarcomas, diagnosed over a period of 10 years at a tertiary cancer hospital in India. Virchows Arch 2008G453i2jF141-153@mEV level Ⅴn
7j T2R00002
Weiss SW, Goldblum JRFChapter 34, Osseous soft tissue tomors. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p1039-1040

CQ 2
Žîá‡‚Ì‘ć‚«‚ł‚Ɨǐ«Eˆ««‚Í
—v–ń
Grade C
 
“î•”Žîᇂɂš‚ą‚ÄŽ‰–bŽî‚ÆŒŒŠÇŽîC_ŒoâŽî‚đœ‚­‚ƁC‘ć‚«‚ł‚Ș5 cm ’Ž‚ÌŽîᇂ͈««ŽîᇂƂ ‚é‰Â”\«‚Ș‚‚ąD
y‰đ@àz

—ǐ«Žîᇂ͒·Œa‚Ș5 cm ˆÈ‰ș‚Ì‚à‚Ì‚Ș‘œ‚ąD‘ć‚«‚ł‚ɂ‚ą‚Ä‚Ì•ń‚Ș‚ ‚é‚à‚Ì‚Ć‚ÍCäFâ‹Ś–EŽî‚ÍĆ‘ćŒai’·Œaj5 cm ˆÈ‰ș‚Ì‚à‚Ì‚Ș‘œ‚­miTF00167CEV level ⅤjCiTF00239CEV level ⅤjnC‘«’êüˆÛŽîÇ‚Í’·Œa2 cm ˆÈ‰șiTF00241CEVlevel ⅤjC•œŠŠ‹ŰŽî‚Í2 cm ˆÈ‰ș‚Ș‘œ‚ą‚Æ•ń‚ł‚ê‚Ä‚ą‚émiTF01152jCiTF01186CEV level ⅤjnD_ŒoâŽî‚à‘œ‚­‚Í3 cm ˆÈ‰șiTF01151j‚Ć‚ ‚é‚Ș5 cm ‚đ’Ž‚Š‚é‚à‚Ì‚à‚ ‚èC‚ł‚ç‚ɁCŽ‰–bŽîCŒŒŠÇŽî‚Ì‚È‚©‚É‚Í10 cm ‚đ’Ž‚Š‚é‚à‚Ì‚à­‚È‚­‚È‚ąDmiT2F01195CEV level ⅤjCiTF01447CEV level Ⅴjn‚Ü‚œC—ǁEˆ««‚Ì’†ŠÔŒ^‚ÉŠÜ‚Ü‚ê‚é—ȚäFŽî‚Ć‚Í5 cm ‚đ’Ž‚Š‚é‚à‚Ì‚à‘œ‚ąD

2009 ”N‚Ì‘S‘œE“î•”Žîᇓo˜^‚É‚æ‚é‚Æ“î•”“śŽî3,779 —áiƒTƒCƒY•s–Ÿ—á‚đœ‚­j’†C5 cm ˆÈ‰ș‚Ì‚à‚Ì‚Í1,039 —ái27.5“jC5 cm ‚æ‚è‘ć‚«‚ą‚à‚Ì‚Í2,740 —ái72.5“j‚Æ•ń‚ł‚ê‚Ä‚ą‚éiT2R00008jD‚”‚œ‚Ș‚Á‚Ä5 cm ‚đ’Ž‚Š‚éŽîá‡‚Ć‚Í‰æ‘œf’f‚Ć–Ÿ‚ç‚©‚ɗǐ«ŽîᇂƐf’f‚ł‚ê‚é‚à‚Ì‚đœ‚ą‚Ă͈««Žîᇂđl‚Š‚é‚Ś‚«‚Ć‚ ‚éD

‚È‚šŽîᇂ̑gDŒ^‚É‚©‚©‚í‚ç‚ž‘ć‚«‚ł‚Ș5 cm ‚đ’Ž‚Š‚éŽîᇂ̗\Œă‚́C‚»‚êˆÈ‰ș‚ÌŽîᇂɔ䂦“ŒvŠw“I‚É—LˆÓ‚É•s—Ç‚Ć‚ ‚邱‚Æ‚ȘC‘œ‚­‚ÌŒ€‹†‚Ć–Ÿ‚ç‚©‚É‚ł‚ê‚Ä‚ą‚éi‘æ7 ÍCQ1 ŽQÆjD

y•¶@ŒŁz
1j TF00167
Peh WC, Wong Y, Shek TW et alFGiant cell tumour of the tendon sheath of the handFa pictorial essay. Australas Radiol 2001G45i3jF274-280@mEV level Ⅴn
2j TF00239
Monaghan H, Salter DM, Al-Nafussi AFGiant cell tumour of tendon sheathilocalised nodular tenosynovitisjFclinicopathological features of 71 cases. J Clin Pathol 2001G54i5jF404-407@mEV level Ⅴn
3j TF00241
Bedi DG, Davidson DMFPlantar fibromatosisFmost common sonographic appearance and variations. J Clin Ultrasound 2001G29i9jF499-505@mEV level Ⅴn
4j TF01152
Giannakopoulos PN, Sotereanos DG, Tomaino MM et alFBenign and malignant muscle tumors in the hand and forearm. Hand Clin 1995G11i2jF 191-201
5j TF01186
Lawson GM, Salter DM, Hooper GFAngioleiomyomas of the hand. A report of 14 cases. J Hand Surgm Brn 1995G20i4jF479-483@mEV Level‡Xn
6j TF01151
Idler RSFBenign and malignant nerve tumors. Hand Clin 1995G11i2jF203-209
7j T2F01195
Billing V, Mertens F, Domanski HA et alFDeep-seated ordinary and atypical lipomasFhistopathology, cytogenetics, clinical features, and outcome in 215 tumours of the extremity and trunk wall. J Bone Joint Surg Br 2008G90i7jF 929-933@mEV level Ⅴn
8j TF01447
Kang B, Zhu TB, Liu JR et alFSonographic diagnosis of intramuscular hemangiomas. J Tongji Med Univ 1993G13i3jF161-162@mEV level Ⅴn
9j T2R00008
“ú–{źŒ`ŠO‰ÈŠw‰ï œE“î•”Žîᇈψő‰ï^‘—§‚Ș‚ńŒ€‹†ƒZƒ“ƒ^[i•ÒjF‘S‘œE“î•”Žîᇓo˜^ˆê——•\C2009

CQ 3
Žîá‡‚Ì‹ÇĘ‚Í
—v–ń
Grade C
 
 
óĘ«‚É”­¶‚”‚â‚·‚ą—ǐ«•a•Ï‚ɂ́CŒ‹ß«‹Ű–Œ‰ŠCŒŒŠÇ•œŠŠ‹ŰŽîCƒKƒ“ƒOƒŠƒIƒ“C•ČᎂȂǂȘ‚ ‚éDˆ««Žîᇂ̑œ‚­‚͐[Ę«”­¶‚Ć‚ ‚é‚ȘC—Č‹N«”畆üˆÛ“śŽîC—Ță”ç“śŽîC”S‰tüˆÛ“śŽî‚Ȃǂ͐óĘ«‚É‚à”­¶‚”‚â‚·‚ąD
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Žîá‡‚Ì‹ÇĘ‚Ș•\Ę‹Ű–Œ‚æ‚è[‚ąŠC‹Ű“ś“à‚â‹ŰŠÔ‚È‚Ç‚É‹ÇĘ‚·‚é‚à‚Ì‚đ[Ę«‚ÆŒÄ‚ŃC”ç‰ș‚Ć•\Ę‹Ű–Œ‚æ‚èó‚ąŠ‚É”­¶‚”‚œŽîᇂđóĘ«‚ƌĂԁD

óĘ«‚É”­¶‚”‚â‚·‚ąŽîᎂƂ”‚ẮCŒ‹ß«‹Ű–Œ‰ŠiT2R00002jCŒŒŠÇ•œŠŠ‹ŰŽîiTF01186CEV level ⅤjCƒKƒ“ƒOƒŠƒIƒ“C•ČᎂȂǂȘ‚ ‚éD

ŒŒŠÇŽî‚͐óĘ«C[Ę«‚Ç‚ż‚ç‚É‚à”­¶‚”‚€‚é‚ȘCóĘ«‚ÌŒŒŠÇŽî‚Ƃ͔畆F‚̕ω»‚âGf‚Ć”äŠr“I_‚ç‚©‚ą‚È‚Ç‚Æ‚ą‚€“Á’„‚đŽŠ‚·‚±‚Æ‚Ș‘œ‚ąD

‚Ü‚œŽ‰–bŽî‚àóĘ«C[Ę«‚Ç‚ż‚ç‚É‚à”­¶‚”CGf‚Ćˆê—l‚ɏ_‚ç‚©‚ąŽîᇂƂ”‚ĐG‚ê‚éDŽ‰–bŽîCŒŒŠÇŽî‚Ì”­¶•p“x‚Í”äŠr“I‚‚ą‚œ‚߁CóĘ«‚ÌŽîᇂđ‚Ę‚œ‚猋ß«‹Ű–Œ‰ŠCŒŒŠÇ•œŠŠ‹ŰŽîCƒKƒ“ƒOƒŠƒIƒ“C•ČᎂɉÁ‚Š‚āCŒŒŠÇŽîCŽ‰–bŽî‚È‚Ç‚đŠÓ•Êf’f‚É“ü‚ê‚é•K—v‚Ș‚ ‚éD

ˆ««Žîᇂ̑œ‚­‚͐[Ę«”­¶‚Ć‚ ‚é‚ȘCóĘ«‚É”­¶‚”‚â‚·‚ą‚à‚Ì‚Æ‚”‚āC—Č‹N«”畆üˆÛ“śŽîC—Ță”ç“śŽîC”S‰tüˆÛ“śŽî‚È‚Ç‚Ș‚ ‚éD—Č‹N«”畆üˆÛ“śŽîC—Ță”ç“śŽî‚Í”äŠr“I‚ä‚Á‚­‚èis‚·‚邱‚Æ‚à‚ ‚èi”N’PˆÊ‚Ì‚±‚Æ‚à‚Ü‚ê‚Ć‚Í‚È‚ąj‘ć‚«‚ł‚à”cm ’ö“x‚Ì‚±‚Æ‚à‚ ‚é‚Ì‚ĆC—ǐ«Žîᇂƌë‚è‚â‚·‚ąD

y•¶@ŒŁz
1j T2R00002
Weiss SW, Goldblum JRFChapter 8, Benign fibroblastic/myofibroblastic proliferations. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-ElsevierC St LouisG2008, p177
2j TF01186
Lawson GM, Salter DM, Hooper GFAngioleiomyomas of the hand. A report of 14 cases. J Hand Surgm Brn 1995G20i4jF479-483@mEV Level‡Xn

CQ 4
Žîᇂ̐«ó‚Í
—v–ń
Grade C
 
 
”ç‰ș”­¶‚Ə_‚ç‚©‚ąŽîᇂ͗ǐ«‚Ć‚ ‚邱‚Æ‚Ș‘œ‚ąDˆ««Žîᇂ́C•\–Ê•œŠŠ‚à‚”‚­‚ÍŒ‹ßó‚ƁC’e«d‚Ć‚ ‚邱‚Æ‚Ș‘œ‚­C‹«ŠE‚Í–Ÿ—Ä‚È‚±‚Æ‚Ș‚ ‚éD‚”‚©‚”Žîᇂ̐«ó‚Ì‚Ę‚©‚ç—ǁEˆ««‚đ”»’f‚·‚邱‚Ƃ͍ą“ï‚È‚±‚Æ‚Ș‘œ‚ąD
y‰đ@àz

”ç‰ș‚ÌŽîᇂƏ_‚ç‚©‚ą«ó‚đŽŠ‚·Žîᇂ͎‰–bŽî‚ÆŒŒŠÇŽîCƒŠƒ“ƒpŠÇŽî‚È‚Ç‚Ć‚ ‚éDŒŒŠÇŽî‚͈ł”—‚ɂĈłk«‚đŽŠ‚·‚±‚Æ‚à‘œ‚ąD”ç‰ș”­¶‚Ə_‚ç‚©‚ąŽîᇂ͗ǐ«‚Ć‚ ‚邱‚Æ‚Ș‘œ‚ąD

‚Ü‚œˆ««Žîᇂ́C•\–Ê•œŠŠ‚à‚”‚­‚ÍŒ‹ßó‚ƁC’e«d‚Ć‚ ‚邱‚Æ‚Ș‘œ‚ąD‹«ŠE‚à”äŠr“I–Ÿ—ĂƁCœ‚Æ‚Ì–ü’…‚Ș‚È‚Ż‚ê‚Ή“ź«‚à”äŠr“I—ǍD‚Ć‚ ‚éD‚È‚šCGf‚É‚ÄŽîᇂȘ_‚ç‚©‚ą‚©d‚ą‚©”»’f‰Â”\‚Ć‚ ‚é‚Ì‚Í”ç‰șŽîᇂƂ ‚èC[•”‚ÌŽîᇂƂ͔»’f‚Ș‚Ț‚ž‚©‚”‚ąD‚Ü‚œ‰Â“ź«‚Ș—ǍD‚©‚Ç‚€‚©CŽüˆÍ‚Æ‚Ì–ü’…‚Ì—L–ł‚ÉŠÖ‚”‚Ä‚àGf‚É‚Ä‚ ‚é’ö“x”»’f‰Â”\‚Ć‚ ‚éD

[•”‚ÌŽîᇂƁCGfă‰Â“ź«‚Ș—ǍD‚ƁC‰æ‘œf’fă‹«ŠE‘N–Ÿ‚Ć‚ ‚é‚Ɨǐ«Žîᇂđl‚Š‚œ‚­‚È‚é‚ȘCˆ««Žîᇂ̑œ‚­‚Ș‚»‚Ì‚æ‚€‚Ȑ«ó‚đŽŠ‚·‚±‚Æ‚đ’m‚Á‚Ä‚š‚­‚Ś‚«‚Ć‚ ‚éD

‚»‚Ì‘ŒCˆł’É‚Ì‚ ‚éŽîᇂ⎋f‚Ɣ畆‚̐«ó‚Ș•Ï‰»‚Ì‚ ‚éŽîᇂɊւ”‚Ä‚àC’mŽŻ‚đŽ‚Á‚Ä‚š‚­‚Ɛf’f‚̏•‚Ż‚Æ‚È‚éD”畆‚̐F‘f’Ÿ’…‚â”畆‚©‚çˆĂÔF‚ÌŽîᇂȘ“§‚Ż‚ÄŒ©‚Š‚éŽîᇂƂ”‚ẮCŒŒŠÇŽîCƒOƒƒ€ƒXŽîᇂȘ‚ ‚°‚ç‚ê‚éDˆł’ɂ͐_ŒoâŽîCŒŒŠÇŽîCƒOƒƒ€ƒXŽîá‡‚È‚Ç‚É‚Ę‚ç‚ê‚éD_ŒoâŽî‚Ć‚ÍŽîᇕ”‚Ì’@‘Ć‚É‚æ‚è––œ‘€‚É•úŽU‚·‚éáu’É‚Ș“Á’„“I‚Ć‚ ‚éD

”畆‚Ș–c—Č‚·‚é“î•”ŽîᇂƂ”‚ẮC—Č‹N«”畆üˆÛ“śŽî‚Æ—Ță”ç“śŽî‚È‚Ç‚Ș‚ ‚èiT2R00002jC‚ł‚ç‚ɔ畆Šà‚ȘŠÓ•Ê‚É‚ ‚°‚ç‚ê‚éD‚È‚š‚±‚ê‚ç‚ÌŽîᇂƂ͎îᇕ\–Ê‚Ș’Śá‡‰»‚·‚邱‚Æ‚à‚ ‚éD

y•¶@ŒŁz
1j T2R00002
Weiss SW, Goldblum JRFChapter 13, Fibrohistiocytic tumors of intermediate malignancy. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p371-372
2j T2R00002
Weiss SW, Goldblum JRFChapter 37, Malignant soft tissue tumors of uncertain type. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p1191-1192

CQ 5
‘œ”­‚·‚éŽîᇁiŽîᎁj‚Í
—v–ń
Grade C
“î•”‚Ì‘œ”­‚·‚éŽîᎂ͗ǐ«‚Ì‚±‚Æ‚Ș‘œ‚ąD
y‰đ@àz

‘œ”­«‚É”­¶‚·‚é“î•”ŽîᇂƂ”‚ẮC_ŒoüˆÛŽîÇ 1 Œ^ivon Recklinghausen •ajC‘œ”­«_ŒoâŽîiT2R00002j1jC‘œ”­«Ž‰–bŽîiŽ‰–bŽîÇjiT2R00002j2jC‘œ”­«ŒŒŠÇŽî‚È‚Ç‚Ș‚ ‚éD’e«üˆÛŽî‚àŒšb•”‚É—Œ‘€«‚É”­¶‚·‚邱‚Æ‚Ș‚ ‚èiT2R00002j3jŽè¶‚â‘«’ê‚̐üˆÛŽîÇ‚à—Œ‘€«‚É”­¶‚·‚邱‚Æ‚Ș‚ ‚éiTF00241CEV level ⅤjD

”­¶•p“x‚Í’á‚ą‚ȘC—Ță”ç“śŽî‚Í‘œ”­‚·‚錋ß«‚ÌŽîᎂƂ”‚Ä”­Ç‚·‚邱‚Æ‚Ș‚ ‚éiT2F12410CEV level ⅤjD

ŠàŽî‚Ì“î•”“]ˆÚ‚à‘œ”­«‚É‚Ę‚ç‚ê‚邱‚Æ‚Ș‚ ‚èCisŠú‚ÌŠà‚ÌŠłŽÒ‚É‚š‚ą‚Ă͊ӕʐf’f‚É“ü‚ê‚Ä‚š‚­•K—v‚Ș‚ ‚éD

‹Ű“ś“à‚É‘œ”­‚·‚éŽîᎂƂ”‚Ă͏ă‹L‚Ì‘œ”­«‚É”­¶‚·‚é“î•”Žîᇂ̂ق©ƒTƒ‹ƒRƒCƒh[ƒVƒX‚àŠÓ•Ê‚É‚ ‚°‚ç‚ê‚éD

y•¶@ŒŁz
1j T2R00002
Weiss SW, Goldblum JRFChapter 29, Benign tumors of peripheral nerves. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG 2008, p870
2j T2R00002
Weiss SW, Goldblum JRFChapter 15, Benign lipomatous tumors. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p436
3j T2R00002
Weiss SW, Goldblum JRFChapter 15, Benign fibroblastic/myo fibroblastic proliferations. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p207-208
4j TF00241
Bedi DG, Davidson DMFPlantar fibromatosisFmost common sonographic appearance and variations. J Clin Ultrasound 2001G29i9jF499-505@mEV level Ⅴn
5j T2F12410
Chbani L, Guillou L, Terrier P et alFEpithelioid sarcomaFa clinicopathologic and immunohistochemical analysis of 106 cases from the French sarcoma group. Am J Clin Pathol 2009G131i2jF222-227@mEV level Ⅴn

CQ 6
’É‚Ę‚đ”ș‚€ŽîᇂÍ
—v–ń
Grade B
 
 
áu’É‚đ“Á’„‚Æ‚·‚éŽîᇂƂ”‚ẮC—ǐ«“î•”ŽîᇂƂ͌ŒŠÇŽîCƒOƒƒ€ƒXŽîᇁCŒŒŠÇ•œŠŠ‹ŰŽîCƒŠƒ“ƒpŠÇŽîC_ŒoâŽî‚Ș‚ ‚éD“î•”“śŽî‚Ć‚ÍŠŠ–Œ“śŽîCˆ««––œ_ŒoâŽîᇂȘŽ©”­’É‚đ‚«‚œ‚·‚±‚Æ‚Ș‚ ‚éD
y‰đ@àz

ˆ««œŽîᇂ̑œ‚­‚Ș’É‚Ę‚đ”ș‚€‚̂ɑ΂”‚āC“î•”Žîᇂ͗ǐ«‚Ć‚àˆ««‚Ć‚ ‚Á‚Ä‚à’É‚Ę‚đ”ș‚í‚È‚ą‚±‚Æ‚Ș‘œ‚ąD‚”‚œ‚Ș‚Á‚āC’É‚Ę‚đ”ș‚€ŽîᇂɊւ”‚Ä’mŽŻ‚đ“Ÿ‚é‚±‚Ƃ͐f’fă—L—p‚Ć‚ ‚éD

áu’É‚đ“Á’„‚Æ‚·‚éŽîᇂƂ”‚ẮC—ǐ«“î•”ŽîᇂƂ͌ŒŠÇŽîiT2F00622CEV level ⅤjCƒOƒƒ€ƒXŽîᇁmiTF00216CEV level ⅤjCiTF00085CEV level ⅤjnCŒŒŠÇ•œŠŠ‹ŰŽîmiTF01152jCiTF01186CEV level Ⅴjn‚È‚Ç‚Ș‚ ‚éD_ŒoâŽî‚Í’@‘ƒɁCˆł’É‚Ș“Á’„“I‚Ć‚ ‚é‚ȘCŽ©”­’É‚ÍŽîᇂȘ‘ć‚«‚­‚È‚ç‚È‚Ż‚ê‚Αœ‚­‚Í‚È‚ąiT2R00002j5jDŒŒŠÇŽî‚Ìáu’É‚ÍŒo‰ß‚ɂďÁŽž‚·‚é‚ȘC‚Ü‚œ’É‚Ę‚Ș”­¶‚·‚é‚Æ‚ą‚€‚±‚Æ‚đŒJ‚è•Ô‚·‚Ì‚Ș“Á’„‚Ć‚ ‚éDƒOƒƒ€ƒXŽîᇂ͎vtŠú‚©‚琏l‚̏—«‚ɍD”­‚”Cáu’É‚Í‚Ù‚Ú‘S—á‚É”F‚ß‚ç‚êCŽ‘±«‚ƁCˆł’ɁC’@‘Ć’É‚Í’˜‚”‚­CˆÀĂŽž‚É‚à¶‚¶‚éDŽwë•”‚Ìáu’É‚đ‘i‚Š‚Ä—ˆ‰@‚”‚œŠłŽÒ18 —á’†14 —á‚̓Oƒƒ€ƒXŽîᇂƂ ‚èC3 —á‚ȘŒŒŠÇŽîC1 —á‚Ș_ŒoâŽî‚Æ‚Ì•ń‚Ș‚ ‚éiTF00085CEV level ⅤjD

’É‚Ę‚đ”ș‚€”ńŽîᇐ«‚ÌŽîᎂƂ”‚Ä‚ÍŒ‹ß«‹Ű–Œ‰Š‚Ș‚ ‚éD‚Æ‚­‚É‘O˜r‚Ć”ç‰ș‚ÌŽîᎂȘ’É‚Ę‚Æ‚Æ‚à‚É“Ë‘R‚ɏoŒ»‚”‚œê‡‚ÍŒ‹ß«‹Ű–Œ‰ŠiT2R00002j7j‚ȘŠÓ•Êf’f‚É‘æˆê‚É‚ ‚°‚ç‚ê‚éD

‚Ü‚œ’É‚Ę‚Æ‚Æ‚à‚É‹}‘Ź‚ɏoŒ»‚”‚œ[•”‚ÌŽîᎂƂ́Cí‚ÉŒŒŽî‚đŠÓ•Êf’f‚É‚ ‚°‚Ä‚š‚­•K—v‚Ș‚ ‚éD

ˆ««ŽîᇂƂ͊Š–Œ“śŽîmiTF00526CEV level ⅤjCiT2F01196CEV level ⅤjnCˆ««––œ_ŒoâŽîᇁiT2R00002j10j‚ȘŽ©”­’É‚đ‚«‚œ‚·‚±‚Æ‚Ș‚ ‚éD

y•¶@ŒŁz
1j T2F00622
Tang P, Hornicek FJ, Gebhardt MC, et alFSurgical treatment of hemangiomas of soft tissue. Clin Orthop Relat Res 2002G399F205-210@mEV level Ⅴn
2j TF00216
Takata H, Ikuta Y, Ishida O et alFTreatment of subungual glomus tumour. Hand Surg 2001G6i1jF25-27@mEV level Ⅴn
3j TF01152
Giannakopoulos PN, Sotereanos DG, Tomaino MM et alFBenign and malignant muscle tumors in the hand and forearm. Hand Clin 1995G11i2jF 191-201
4j TF01186
Lawson GM, Salter DM, Hooper GFAngioleiomyomas of the hand. A report of 14 cases. J Hand Surgm Brn 1995G20i4jF479-483@mEV Level‡Xn
5j T2R00002
Weiss SW, Goldblum JRFChapter 29, Benign tumors of peripheral nervers. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG 2008, p853
6j TF00085
Bhaskaranand K, Navadgi BCFGlomus tumour of the hand. J Hand SurgmBrn2002G27i3jF229-231@mEV level Ⅴn
7j T2R00002
Weiss SW, Goldblum JRFChapter 8, Benign fibroblastic/myofibroblastic proliferations. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p177
8j TF00526
Scully SP, Temple HT, Harrelson JMFSynovial sarcoma of the foot and ankle. Clin Orthop Relat Res 1999G364F220-226@mEV level Ⅴn
9j T2F01196
Chotel F, Unnithan A, Chandrasekar CR et alFVariability in the presentation of synovial sarcoma in childrenFa plea for greater awareness. J Bone Joint Surg Br 2008G90i8jF1090-1096@mEV level Ⅴn
10j T2R00002
Weiss SW, Goldblum JRFChapter 30, Malignant tumors of the peripheral nerves. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008, p904

CQ 7
Š‘źƒŠƒ“ƒpß‚ÌŽî‘ć‚Ș‚ ‚Á‚œê‡‚Í
—v–ń
Grade C
 
Š‘źƒŠƒ“ƒpß“]ˆÚ‚đ‚«‚œ‚”‚â‚·‚ą“î•”“śŽî‚́C‰Ą–ä‹Ű“śŽîC’W–ŸŚ–E“śŽîC—Ță”ç“śŽîCŒŒŠÇ“śŽî‚È‚Ç‚Ć‚ ‚éD
y‰đ@àz

“î•”“śŽî‚̉“Šu“]ˆÚ‚ÍŒŒs«‚ɐ¶‚¶‚邱‚Æ‚Ș‘œ‚­C”x‚Ș‘æˆê‚Ì•W“I‘ŸŠí‚É‚È‚éD‚”‚©‚”C‚È‚©‚ɂ̓Šƒ“ƒpß‚Ö‚Ì“]ˆÚ‚𐶂¶‚é‚à‚Ì‚à‚ ‚éD‰Ą–ä‹Ű“śŽîC’W–ŸŚ–E“śŽîC—Ță”ç“śŽî‚ȘƒŠƒ“ƒpß“]ˆÚ‚đ‚«‚œ‚”‚â‚·‚ą‚±‚Æ‚Ș’m‚ç‚ê‚Ä‚ą‚éD‰fŽž‚ɃŠƒ“ƒpß‚Ì“]ˆÚ‚Ș”F‚ß‚ç‚ê‚銄‡‚͐Źl‚̉Ą–ä‹Ű“śŽî‚É‚š‚ą‚Ä‚Í84 —á’†27 —ái34“jiT2F04765CEV level ⅤjC’W–ŸŚ–E“śŽî‚Ć‚Í75 —á’†17 —ái23“jiT2F00462CEV level ⅤjC—Ță”ç“śŽî‚Ć‚Í106 —á’†5 —ái6 “jiT2F12410CEV level ⅤjCŒŒŠÇ“śŽî161 —á’†5 —ái3“jiT2F03439CEV level Ⅴj‚Ć‚ ‚Á‚œ‚Æ‚»‚ê‚Œ‚ê•ń‚ł‚ê‚Ä‚ą‚éD‚Ü‚œŽîᇈȊO‚Ƃ́C‚œ‚Æ‚Š‚ÎŽîᇂ̂ ‚éŽlŽˆ‚ÉŠŽőÇ‚Ș‚ ‚èCŠ‘źƒŠƒ“ƒpß‚Ș–c’Ż‚·‚邱‚Æ‚à‚ ‚é‚Ì‚ĆCŠŽőÇ‚Ì—L–ł‚̃`ƒFƒbƒN‚Ș•K—v‚Ć‚ ‚éD

y•¶@ŒŁz
1j T2F04765
Little DJ, Ballo MT, Zagars GK et alFAdult rhabdomyosarcomaFoutcome following multimodality treatment. Cancer 2002G95i2jF377-388@mEV level Ⅴn
2j T2F00462
Kawai A, Hosono A, Nakayama R et alFClear cell sarcoma of tendons and aponeurosesFa study of 75 patients. Cancer 2007G109i1jF109-116@mEV level Ⅴn
3j T2F12410
Chbani L, Guillou L, Terrier P et alFEpithelioid sarcomaFa clinicopathologic and immunohistochemical analysis of 106 cases from the French sarcoma group. Am J Clin Pathol 2009G131i2jF222-227@mEV level Ⅴn
4j T2F03439
Fayette J, Martin E, Piperno-Neumann S et alFAngiosarcomas, a heterogeneous group of sarcomas with specific behavior depending on primary siteFa retrospective study of 161 cases. Ann Oncol 2007G18i12jF 2030-2036@mEV level Ⅴn

CQ 8
—Տ°ŒŸž’l‚ĆˆÙí‚đŽŠ‚·ŽîᇂÍ
—v–ń
Grade C
 
—Տ°ŒŸž’l‚Ć“î•”“śŽî‚É“ÁˆÙ“I‚È‚à‚́i“î•”“śŽî‚ÌŽîᇃ}[ƒJ[j‚͈ê”Ê“I‚É‚Í‚È‚ą‚ȘCŽîᇃTƒCƒY‚Ì‘ć‚«‚ȍ‚ˆ««“x“î•”ŽîᇂƂÍLDH ‚Ìăž‚đ”F‚߂邱‚Æ‚Ș‚ ‚éD
y‰đ@àz

—Տ°ŒŸž’l‚Ć“î•”“śŽî‚É“ÁˆÙ“I‚È‚à‚́i“î•”“śŽî‚ÌŽîᇃ}[ƒJ[j‚͈ê”Ê“I‚É‚Í‚È‚ąD‚”‚©‚”ŽîᇃTƒCƒY‚Ì‘ć‚«‚ȍ‚ˆ««“x“î•”“śŽîC‚ ‚é‚ą‚Í‘œ”­«‚É“]ˆÚ‚”‚Đis‚”‚œ“î•”“śŽî‚Ƃ́CŠàŽî‚Æ“Ż—l‚ÉLDH ‚Ìăž‚đ”F‚߂邱‚Æ‚Ș‚ ‚éDLDH ăž‚ÍŽîᇂȘ‘‘ć‚”CŽîᇍŚ–E‚̈ꕔ‚Ș‰óŽ€‚·‚邱‚Æ‚É‚æ‚è‰óŽ€‚”‚œŚ–E‚æ‚èLDH ‚ȘŒŒ‰t’†‚É‚Ć‚é‚œ‚߂ƍl‚Š‚ç‚ê‚éD

‚Ü‚œˆ««üˆÛ«‘gD‹…ŽîiTF00061CEV level Ⅴj‚⍜ŠO«Ewing “śŽî‚Ć‚Í”’ŒŒ‹…‘‘œCŒŒŽCRP ‚’l‚Ș”F‚ß‚ç‚ê‚邱‚Æ‚Ș‚ ‚éD

Ć‹ß‚ÌŒ€‹†‚ƁC—Ță”ç“śŽî‚ɑ΂”‚ÄCA125 ‚ȘŽîᇃ}[ƒJ[‚Æ‚È‚è‚€‚邱‚Æ‚Ș•ń‚ł‚êiT2F12413CEV level ⅤjC‚Ü‚œ‚»‚ÌŒŒ’†”Z“x‚ȘŽîᇑB‚Æ‘ŠŠÖ‚”‚Ä‚ą‚邱‚Æ‚à•ń‚ł‚ê‚Ä‚ą‚éiT2F12411CEV level ⅤjD

‚ł‚ç‚É’·Šú‚̍œ’ɁCŒJ‚è•Ô‚·•a“IœÜC’჊ƒ“ŒŒÇ‚đŽŠ‚·Žîᇐ«œ“Ç‚Ƃ́CŒŽˆöŽîᇂƂ”‚Ä“î•”ŽîᇂƍœŽîᇂȘ•ń‚ł‚ê‚Ä‚š‚èCüˆÛ‰èŚ–E‘BˆöŽq23iFGF23j‚Șƒ}[ƒJ[‚Æ‚È‚è‚€‚邱‚Æ‚Ș•ń‚ł‚ê‚Ä‚ą‚éiT2F12412CEV level ⅤjD

‚È‚š“î•”ŽîᇂƊӕʂ·‚Ś‚«ŽîᇂƂ ‚鈫«ƒŠƒ“ƒpŽî‚É‚š‚ą‚ẮC‰Â—n«ƒCƒ“ƒ^[ƒƒCƒLƒ“2 Žó—e‘́isIL-2Rj‚Șăž‚·‚邱‚Æ‚Ș‘œ‚­Cf’f‚̕⏕‚â•aš‚̃}[ƒJ[‚Æ‚”‚Ä—p‚ą‚ç‚ê‚Ä‚ą‚éD‚œ‚Ÿ‚”CsIL-2R ‚̓Šƒ“ƒpßŽî’Ż‚đ”F‚ß‚éŽíX‚ÌŽŸŠł‚Ə㏾‚·‚邱‚Æ‚Ș’m‚ç‚ê‚Ä‚š‚èCˆ««ƒŠƒ“ƒpŽî‚É“ÁˆÙ“I‚ȃ}[ƒJ[‚Ć‚Í‚È‚ąD

y•¶@ŒŁz
1j TF00061
Nakanishi H, Araki N, Kudawara I et alFClinical implications of serum C-reactive protein levels in malignant fibrous histiocytoma. Int J Cancer 2002G99i2jF167-170@mEV level Ⅴn
2j T2F12413
Kato H, Hatori M, Kokubun S et alFCA125 Expression in Epithelioid Sarcoma. Jpn J Clin Oncol 2004G34i3jF149-154@mEV level Ⅴn
3j T2F12411
Hoshino M, Kawashima H, Ogose A et alFSerum CA 125 expression as a tumor marker for diagnosis and monitoring the clinical course of epithelioid sarcoma. J Cancer Res Clin Oncol G136i3jF457-464@mEV level Ⅴn
4j T2F12412
Imel EA, Peacock M, Pitukcheewanont P et alFSensitivity of fibroblast growth factor 23 measurements in tumor-induced osteomalacia. J Clin Endocrinol Metab 2006G91i6jF2055-2061@mEV level Ⅴn

‘æ‚SÍ@‰æ‘œf’f

Clinical QuestionE„§ˆê——‚Ö


CQ 1
—L—p‚ȉ摜f’f‚Í
—v–ń
Grade B
 
ŒŽ”­Žîᇂɑ΂”‚Ä‚ÍMRI ‚É‚æ‚é•]‰ż‚Ș–]‚Ü‚”‚ąD
•aŠúf’f‚ɂ́C‹č•”CT ‚đŽÀŽ{‚·‚邱‚Æ‚Ș–]‚Ü‚”‚ąD
y‰đ@àz

MRI ‚Í‘gD•Ș‰đ”\‚É—D‚ê‚Ä‚ą‚āC“î•”Žîᇂ̐«ó‚đ•]‰ż‚·‚é‚Ì‚ÉĆ‚à“K‚”‚œ‰æ‘œŒŸž‚Ć‚ ‚éD‚”‚©‚”C–{ÍCQ5 ‚Ć‹LÚ‚·‚é‚æ‚€‚ɁCMRI ‚Ì‚Ę‚Ćf’f‰Â”\‚ÈŽîᇂ͑œ‚­‚È‚ą‚±‚Æ‚É’ˆÓ‚·‚Ś‚«‚Ć‚ ‚èC—ǁEˆ««‚ÌŠÓ•Ê‚àą“ï‚È‚±‚Æ‚Ș‘œ‚ąD•K—v‚ɉž‚¶‚ÄCT ‚â’Ž‰č”g‚È‚Ç‚Ì‘Œ‚̉摜ŒŸž‚đ’ljÁ‚·‚éiT2F12384jD“î•”“śŽî‚Ì‘œ‚­‚Í”x‚É“]ˆÚ‚·‚é‚œ‚߁C•aŠúf’f‚ɂ́C‹ÇŠ‚Ì•]‰ż‚ɉÁ‚Š‚āC‹č•”CT ‚đŽB‘œ‚·‚邱‚Æ‚Ș–]‚Ü‚”‚ąmiT2F12384jCiT2F03450jnD

y•¶@ŒŁz
1j T2F12384
Grimer R, Judson I, Peake D et alFGuidelines for the management of soft tissue sarcomas. Sarcoma 2010G2010F506182
2j T2F03450
Casali PG, Jost L, Sleijfer S et alFSoft tissue sarcomasFESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008G 19 Suppl 2Fii89-93

CQ 2
X üŒŸž‚Ì—L—p«‚Í
—v–ń
Grade B
X ü‘œ‚Ć—L—p‚ȏŠŒ©‚đ’æ‚·‚éŽîᇂȘ‚ ‚éD
y‰đ@àz

Ž‰–bŽî‚Ć‚ÍŽ‰–b‚ƈê’v‚”‚œ“§‰ß«‚̘Ži‚Ș‚Ę‚ç‚ê‚éiTF00113jDœ‰»«‹Ű‰Š‚Ć‚ÍŽîᎂ̕Ӊ‚É‹­‚­œ‰»‚Ș”F‚ß‚ç‚ê‚éizoning phenomenonjmiTF01475CEV level ⅤjCiTF01152jnD‚±‚ê‚ɑ΂”‚čœŠO«œ“śŽî‚Í’†S•”‚É•s‹K‘„‚ȍœŒ`Ź‚đŽŠ‚·miTF01475CEV level ⅤjCiTF01116CEV level ⅤjnDŒŒŠÇŽî‚̐ΊD‰»‚Í‘ćŹ‚Ì‹«ŠE–Ÿ—Ä‚ÈŠÛ‚ąÎŠD‰»iĂ–ŹÎj‚Ș“Á’„“I‚Ć‚ ‚èCŽíX‚ÌŠ„‡‚ƏoŒ»‚·‚émiTF00113jCiT2F02141CEV level Ⅴ jCiT2F01065CEV level Ⅴ jCiT2F00622CEV level ⅤjCiT2F00298CEV level ⅤjnDˆ««ŽîᇂƂ́CŠŠ–Œ“śŽîmiTF00113CEV leveljCiT2F02037CEV level ⅤjCiT2F00410jCiT2F00699jnCœŠO«œ“śŽîmiTF01475CEV level ⅤjCiTF01116CEV level Ⅴjn‚É‚š‚ą‚ĐΊD‰»‚đ’æ‚·‚邱‚Æ‚Ș‘œ‚ąD

—ŚÚœ”玿‚̕ω»‚Ƃ́CŒŒŠÇŽî‚Ć‚Íœ”玿‚Ì”ìŒú‚đ”F‚ß‚éê‡‚Ș‚ ‚éDäFâ‹Ś–EŽî‚Ć‚Íœ”玿‚Ì‚Ń‚ç‚ńmiT2F00856CEV level ⅤjCiT2F01380CEV level ⅤjnC‚Ń‚Ü‚ńŒ^‹Ś–EŽîiF‘f«ăO–ŃŒ‹ß«ŠŠ–Œ‰Šj‚Ì“Á‚ɌҊ֐ߔ­¶‚â‘«E‘«ŠÖßŽüˆÍ”­¶‚Ć‚Íœ”玿‚Ì‚Ń‚ç‚ńE”XŽîŒ`Ź‚Ș”F‚ß‚ç‚ê‚éê‡‚Ș‚ ‚émiTF00113jCiT2F00892CEV level Ⅴ jCiTF00196CEV level Ⅴ jCiTF01231CEV level Ⅴ jCiTF00195CEV level ⅤjnDŠŠ–Œ«œ“ŽîÇ‚Ć‚àœ‚Ń‚ç‚ń‚Ș”F‚ß‚ç‚ê‚邱‚Æ‚Ș‚ ‚éiT2F00857CEV level ⅤjDˆ««ŽîᇂƂ͗ŚÚœ‚ւ̐ZE”j‰ó‚Ș‚Ę‚ç‚ê‚邱‚Æ‚Ș‚ ‚éiT2F02037CEV level ⅤjD

y•¶@ŒŁz
1j TF00113
Bancroft LW, Peterson JJ, Kransdorf MJ et alFSoft tissue tumors of the lower extremities. Radiol Clin North Am 2002G40i5jF991-1011
2j TF01475
Kransdorf MJ, Meis JMFFrom the archives of the AFIP. Extraskeletal osseous and cartilaginous tumors of the extremities. Radiographics 1993G13i4jF853-884@mEV level Ⅴn
3j TF01152
Giannakopoulos PN, Sotereanos DG, Tomaino MM et alFBenign and malignant muscle tumors in the hand and forearm. Hand Clin 1995G11i2jF 191-201
4j TF01116
Lee JS, Fetsch JF, Wasdhal DA et alFA review of 40 patients with extraskeletal osteosarcoma. Cancer 1995G76i11jF2253-2259@mEV level Ⅴn
5j T2F02141
Griffin N, Khan N, Thomas JM et alFThe radiological manifestations of intramuscular haemangiomas in adultsFmagnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol 2007G36i11jF1051-1059@mEV level Ⅴn
6j T2F01065
Wu JL, Wu CC, Wang SJ et alFImaging strategies in intramuscular haemangiomasFan analysis of 20 cases. Int Orthop 2007G31i4jF569-575@mEV level Ⅴn
7j T2F00622
Tang P, Hornicek FJ, Gebhardt MC et alFSurgical treatment of hemangiomas of soft tissue. Clin Orthop Relat Res 2002G399F205-210@mEV level Ⅴn
8j T2F00298
Wild AT, Raab P, Krauspe RFHemangioma of skeletal muscle. Arch Orthop Trauma Surg 2000G120i3-4jF139-143@mEV level Ⅴn
9j T2F02037
Marzano L, Failoni S, Gallazzi M et alFThe role of diagnostic imaging in synovial sarcoma. Our experience. Radiol Med 2004G107i5-6jF533-540@mEV level Ⅴn
10j T2F00410
O'Sullivan PJ, Harris AC, Munk PLFRadiological features of synovial cell sarcoma. Br J Radiol 2008G81i964jF346-356
11j T2F00699
Stacy GS, Nair LFMagnetic resonance imaging features of extremity sarcomas of uncertain differentiation. Clin Radiol 2007G62i10jF950-958
12j T2F00856
De Schepper AM, Hogendoorn PC, Bloem JLFGiant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions. Eur Radiol 2007G17i2jF499-502@mEV level Ⅴn
13j T2F01380
Uriburu IJ, Levy VDFIntraosseous growth of giant cell tumors of the tendon sheathilocalized nodular tenosynovitisjof the digitsFreport of 15 cases. J Hand Surg Am 1998G23i4jF732-736@mEV level Ⅴn
14j T2F00892
Saxena A, Perez HFPigmented villonodular synovitis about the ankleFa review of the literature and presentation in 10 athletic patients. Foot Ankle Int 2004G25i11jF819-826@mEV level Ⅴn
15j TF00196
Gonzalez Della Valle A, Piccaluga F, Potter HG et alFPigmented villonodular synovitis of the hipF2- to 23-year followup study. Clin Orthop Relat Res 2001G388F187-199@mEV level Ⅴn
16j TF01231
Cotten A, Flipo RM, Chastanet P et alFPigmented villonodular synovitis of the hipFreview of radiographic features in 58 patients. Skeletal Radiol 1995G 24i1jF1-6@mEV level Ⅴn
17j TF00195
Bhimani MA, Wenz JF, Frassica FJFPigmented villonodular synovitisFkeys to early diagnosis. Clin Orthop Relat Res 2001G386F197-202@mEV level Ⅴn
18j T2F00857
Adams ME, Saifuddin AFCharacterisation of intra-articular soft tissue tumours and tumour-like lesions. Eur Radiol 2007G17i4jF950-958@mEV level Ⅴn

CQ 3
’Ž‰č”gŒŸžiƒGƒR[j‚Ì—L—p«‚Í
—v–ń
Grade C
 
’Ž‰č”gŒŸž‚ÍŽîá‡‚Ì‹ÇĘCŽü•Ó‘gD‚Ƃ̈ʒuŠÖŒW‚Ì•]‰żCŒŒ—Ź‚Ì‘œ‰Ç‚đ•]‰ż‚·‚éê‡‚ɍl—¶‚ł‚ê‚Ä‚à‚æ‚ąD
y‰đ@àz

”­¶•”ˆÊ‚È‚Ç‚Ì—Ő°ŠŒ©‚đ•č‚č‚Ä”»’f‚·‚é‚ƁCŒŒ—Ź‚Ì–L•x‚È’áƒGƒR[‘œ‚Æ‚”‚Ä•`o‚ł‚ê‚éƒOƒƒ€ƒXŽîᇁmiT2F01995CEV level Ⅳ jCiT2F00100CEV level ⅤjnC‘«’êäF–Œ‚ɐڂ”‚茒·‚ąŒ`ó‚ƁC’áƒGƒR[‘œ‚đ’æ‚·‚é‘«’êüˆÛŽîÇiTF00241CEV level ⅤjCŽèŽw‚É”­Ç‚”‚Ä•Ó‰–Ÿ—Ä‚È’áƒGƒR[‘œ‚đ’æ‚·‚éƒKƒ“ƒOƒŠƒIƒ“miT2F00548CEV level ⅤjCiTF01402CEV level Ⅴjn‚Ȃǂ̐f’f‚É—L—p‚Ć‚ ‚éD’Ž‰č”gŒŸž‚ÍŽîᇂ̑¶Ę•”ˆÊ‚đ“Á’è‚·‚é‚Ì‚ÉŠÈ•Ö‚Ć—L—p‚ÈŒŸž‚Ć‚ ‚éD¶ŒŸŽž‚Ì•č—piT2F00548CEV level ⅤjC_Œo”­¶Žîá‡‚ÌœëŠł_Œo‚Ì‘–s‚đ“Á’èmiT2F00091CEV level ⅤjCiT2F01687CEV level ⅣjnC—ŚÚ‚·‚é‘gD‚Ì•]‰żiT2F00487CEV level Ⅴj‚È‚Ç‚É—L—p‚Ć‚ ‚éD

y•¶@ŒŁz
1j T2F01995
Chen SH, Chen YL, Cheng MH et alFThe use of ultrasonography in preoperative localization of digital glomus tumors. Plast Reconstr Surg 2003G 112i1jF115-119Gdiscussion 20@mEV Level Ⅳn
2j T2F00100
Wortsman X, Jemec GBFRole of high-variable frequency ultrasound in preoperative diagnosis of glomus tumorsFa pilot study. Am J Clin Dermatol 2009G10i1jF23-27@mEV level Ⅴn
3j TF00241
Bedi DG, Davidson DMFPlantar fibromatosisFmost common sonographic appearance and variations. J Clin Ultrasound 2001G29i9jF499-505@mEV level Ⅴn
4j T2F00548
Ho CF, Chiou HJ, Chou YH et alFPeritendinous lesionsFthe role of highresolution ultrasonography. Clin Imaging 2003G27i4jF239-250@mEV level Ⅴn
5j TF01402
Bianchi S, Abdelwahab IF, Zwass A et alFSonographic findings in examination of digital gangliaFretrospective study. Clin Radiol 1993G48i1jF 45-47@mEV level Ⅴn
6j T2F00091
Toms AP, Anastakis D, Bleakney RR et alFLipofibromatous hamartoma of the upper extremityFa review of the radiologic findings for 15 patients. Am J Roentgenol 2006G186i3jF805-811@mEV level Ⅴn
7j T2F01687
Tsai WC, Chiou HJ, Chou YH et alFDifferentiation between schwannomas and neurofibromas in the extremities and superficial bodyFthe role of highresolution and color Doppler ultrasonography. J Ultrasound Med 2008G27i2jF 161-166Gquiz 8-9@mEV Level Ⅳn
8j T2F00487
Cheng JW, Tang SF, Yu TY et alFSonographic features of soft tissue tumors in the hand and forearm. Chang Gung Med J 2007G30i6jF547-554mEV level Ⅴn

CQ 4
CT ŒŸž‚Ì—L—p«‚Í
—v–ń
Grade C
 
 
 
Žîᇓà‚ɐΊD‰»‚đ’æ‚·‚éŽîᇂ̊ӕʂâĂ–ŹÎ‚đŒ`Ź‚·‚錌ŠÇŽî‚̐f’f‚É—L—p‚Ć‚ ‚éD
Ž‰–bŽîC‚•Ș‰»Œ^Ž‰–b“śŽîCŽ‰–b‰èŚ–EŽîCŒŒŠÇŽî‚È‚Ç‚ÌŽ‰–bŹ•Ș‚đŠÜ‚ȚŽîᇂ̕]‰ż‚É—L—p‚Ć‚ ‚éD
“î•”ŽîᇂɗŚÚ‚·‚鍜‚⌌ŠÇ‚Ì•]‰ż‚É—L—p‚Ć‚ ‚éD
y‰đ@àz

Žîᇓà‚̐ΊD‰»‚đ•`o‚·‚éă‚ĆCT ‚Í—LŒű‚Ć‚ ‚èC‹Ű“ś“àŒŒŠÇŽîmiT2F02141CEV level ⅤjCiT2F00298CEV level ⅤjnCˆ««ŽîᇂƂ͊Š–Œ“śŽîiT2F00410CEV level Ⅴj‚È‚Ç‚Ć‚Ę‚ç‚ê‚éDŽîᇓà‚ÌŽ‰–bŹ•Ș‚đ•`o‚·‚邱‚Æ‚ĆŽ‰–bŽîC‚•Ș‰»Œ^Ž‰–b“śŽîiT2F01538CEV level Ⅴj‚⎉–b‰èŚ–EŽîiT2F01962CEV level ⅤjCŒŒŠÇŽîiT2F02141CEV level Ⅴj‚̐f’f‚É—L—p‚Ć‚ ‚éDäFâ‹Ś–EŽî‚È‚Ç‚É‚æ‚é—ŚÚ‚·‚鍜”玿‚̕ω»iT2F01380CEV level Ⅴj‚đ•]‰ż‚Ć‚«‚éD

‘ą‰eCT ‚́Cp‘OŽèpŒv‰æ‚É‚š‚ą‚ÄŽîᇂƌŒŠÇ‚̈ʒuŠÖŒW‚âŽîᇂɂæ‚錌ŠÇZ‚Ì—L–ł‚đ•]‰ż‚·‚é‚Ì‚É—L—p‚Ć‚ ‚éiT2F12465CEV level ⅤjD

‹č•”CT ‚́C“î•”“śŽî‚Ì”x“]ˆÚ‚Ì•]‰ż‚É—L—p‚Ć‚ ‚éiGrade BC–{ÍCQ1 ŽQÆjD

y•¶@ŒŁz
1j T2F02141
Griffin N, Khan N, Thomas JM et alFThe radiological manifestations of intramuscular haemangiomas in adultsFmagnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol 2007G36i11jF1051-1059@mEV level Ⅴn
2j T2F00298
Wild AT, Raab P, Krauspe RFHemangioma of skeletal muscle. Arch Orthop Trauma Surg 2000G120i3-4jF139-143@mEV level Ⅴn
3j T2F00410
O'Sullivan PJ, Harris AC, Munk PLFRadiological features of synovial cell sarcoma. Br J Radiol 2008G81i964jF346-356@mEV level Ⅴn
4j T2F01538
Nishida J, Morita T, Ogose A et alFImaging characteristics of deep-seated lipomatous tumorsFintramuscular lipoma, intermuscular lipoma, and lipomalike liposarcoma. J Orthop Sci 2007G12i6jF533-541@mEV level Ⅴn
5j T2F01962
Moholkar S, Sebire NJ, Roebuck DJFRadiological-pathological correlation in lipoblastoma and lipoblastomatosis. Pediatr Radiol 2006G36i8jF851-856@mEV level Ⅴn
6j T2F01380
Uriburu IJ, Levy VDFIntraosseous growth of giant cell tumors of the tendon sheathilocalized nodular tenosynovitisjof the digitsFreport of 15 cases. J Hand Surg Am 1998G23i4jF732-736@mEV level Ⅴn
7j T2F12465
Yamamoto T, Kurosaka M, Soejima T et alFContrast-enhanced threedimensional helical CT for soft tissue tumors in the extremities. Skeletal Radiol 2001G30i7jF384-387@mEV level Ⅴn

CQ 5
MRI ŒŸž‚Șf’f‚É—L—p‚ÈŽîᇂÍ
—v–ń
Grade B
 
Ž‰–bŒnŽîᇁC_ŒoâŽîCŒŒŠÇŽîCƒKƒ“ƒOƒŠƒIƒ“CŠŠ‰t•ï‰ŠCƒŠƒ“ƒpŠÇŽî‚È‚Ç‚Ì”X–E«ŽŸŠł‚Ć‚Í“Á’„“I‚ȏŠŒ©‚É‚æ‚èCf’f“I‰ż’l‚Ș‚ ‚éD
y‰đ@àz

Ž‰–bŽî‚́CŽ‰–b‘gD‚ȘŽć‘Ì‚Ć‚ ‚é‚œ‚ßT1CT2 ‚Ć‚Æ‚à‚ÉŽ‰–b‚Æ“ŻM†‚đŽŠ‚”C‚•Ș‰»Œ^Ž‰–b“śŽî‚Ć‚ÍŽ‰–bŽî‚Æ“Ż—l‚̏ŠŒ©‚đŽŠ‚·‚à‚Ì‚âC“à•”‚Ș•s‹Ïˆê‚Æ‚È‚é‚à‚Ì‚Ș‚ ‚éD—ŒŽÒ‚ÌŠÓ•Ê‚É‚ÍŽ‰–b—}§CT2/STIRishort tau inversion recoveryj‚Ș—L—p‚Ć‚ ‚èCŽ‰–b—}§‚Ć‚Ì‘ą‰eÜ‚ÌŽæ‚荞‚Ę‚Ì—L–ł‚à—L—p‚Ć‚ ‚邱‚Æ‚Ș‘œ‚ąmiT2F00850CEV level ⅣjCiT2F01538CEV level ⅤjCiTF00623CEV level ⅤjnDŠŒFŽ‰–bŽîC—c­Žž‚É”­Ç‚·‚鎉–b‰èŚ–EŽî‚ÍT1 ‚ĆŽ‰–bˆÈŠO‚̐Ź•Ș‚đ•`o‚”CŽ‰–b‚æ‚è’áM†‚đŽŠ‚”CŽ‰–b—}§‚É‚ÄŠź‘S‚É‚Í—}§‚ł‚ê‚È‚ąmiT2F02140CEV level ⅤjCiT2F01962CEV level ⅤjCiT2F00698CEV level ⅤjCiT2F00932CEV level ⅤjnD

_ŒoâŽî‚Ƃ́C_ŒoŽüˆÍ‚É‘¶Ę‚·‚鎉–b‚đ•`o‚·‚ésplit fat signC”­¶Œč‚Ć‚ ‚é_Œo‚đŽŠ‚·entering and exiting nerveCT2 ‚Ć’†S‚Ș’áM†C•Ó‰‚Ș‚M†‚đŽŠ‚”itarget signjC‘ą‰e‚É‚æ‚è’†S‚Ș‘ą‰e‚ł‚ê‚邱‚Æ‚Șf’f‚É—L—p‚Ć‚ ‚émiT2F00075CEV level ⅤjCiT2F00684CEV level ⅣjCiT2F00519CEV level ⅤjnD

ŒŒŠÇŽî‚Í‹«ŠE‚Ș–Ÿ—Ä‚È‚à‚̂ƍL”͈͂ɐZ‚”‚Ä‚ą‚é‚à‚Ì‚Ș‚ ‚èCŽ‰–bŹ•Ș‚đŠÜ‚Ț‚ÆT1 ‚ĆŽ‰–b‚Æ“Ż‚¶M†‚đŽŠ‚·•”•Ș‚Ș‚ ‚éD‚Ü‚œŒŒŽî‚Ș’†‚É’™—Ż‚”CŠíŽż‰»‚”‚Ä‚ą‚È‚ą‚ƐԌŒ‹…Ź•Ș‚ÆŒŒŸśŹ•Ș‚Ș•Ș—Ł‚”‚ÄT2 ‚É‚Äfluid-fluid level ‚đŽŠ‚·‚±‚Æ‚Ș‚ ‚éDŒŒ—Ź‚Ì‚ ‚é•”•Ș‚Í–łM†‚Æ‚”‚Ä•`o‚ł‚êCflow void ‚ƌĂ΂ê‚émiT2F00298CEV level ⅤjCiT2F01065CEV level ⅤjCiT2F02141CEV level ⅤjCiTF00284CEV level ⅤjCiT2F00700CEV level ⅤjnD”X–E‚ÆŒŒŠÇŽî‚̊ӕʁC[ŽÀ«ŽîᇂƌŒŠÇŽî‚ÌŠÓ•Ê‚É‘ą‰eMRI ‚Ș—L—p‚ȏꍇ‚Ș‚ ‚éD

äFâ‹Ś–EŽîC‚Ń‚Ü‚ńŒ^‹Ś–EŽîiF‘f«ăO–ŃŒ‹ß«ŠŠ–Œ‰Šj‚̓wƒ‚ƒWƒfƒŠƒ“ŠÜ—LŚ–E‚ȘoŒ»‚·‚é‚œ‚߁C“SŹ•Ș‚ȘM†‹­“x‚ɉe‹ż‚”‚ÄT1CT2 ‚É‚Ä’áM†‚đŽŠ‚·ŒXŒü‚Ș‚ ‚éDäFEäFâ‚É—ŚÚ‚”‚œ”­¶CŠÖß“à”­Ç‚È‚Ç‚Ì”­¶•”ˆÊ‚Æ•č‚č‚邱‚Æ‚Ćf’f“I‰ż’l‚Ș‚‚Ü‚émiTF00195CEV level ⅤjCiTF01218CEV level ⅤjCiTF00073CEV level‡XjCiTF00167jCiTF00196CEV level‡XjCiTF00539CEV level‡XjCiTF01241CEV level ⅤjCiT2F01645CEV level ⅤjCiT2F00142jCiT2F02107CEV level ⅤjCiT2F00856CEV level ⅤjnD

ŠŠ–Œ“śŽî‚Ƃ́CT2 ‚ɂĉ󎀁E‰t‘Ì‚đŽŠ‚·‚M†CŒŒ‰t‚đŽŠ‚·”äŠr“I‚M†CÎŠD‰»EüˆÛ‘gD‚đŽŠ‚·’áM†‚đ•`o‚”Ctriple signal intensity ‚ƌĂ΂ê‚éDfluidfluid level ‚đ’æ‚·‚邱‚Æ‚à‚ ‚éD‚Ü‚œƒTƒCƒY‚ȘŹ‚ł‚ą‚Æ‹«ŠE–Ÿ—Ä‚Ć“à•”‚Ș‹Ïˆê‚ȏꍇ‚Ș‚ ‚èC—ǐ«‚ƊԈႊ‚ç‚ê‚Đۏœ‚ł‚ê‚â‚·‚ąmiTF00848CEV level ⅤjCiT2F00410CEV level ⅤjCiT2F02037CEV level ⅤjCiT2F02111CEV level ⅤjnD

–E‘ƒó“î•”“śŽî‚Ć‚ÍT1 ‚É‚Ä‹Ű‚æ‚荂M†‚đ’æ‚”CT2 ‚Ć”ńí‚ɍ‚M†‚đŽŠ‚·D–L•x‚ÈŒŒ—Ź‚đ”œ‰f‚”‚Äflow void ‚Ș”F‚ß‚ç‚ê‚émiTF00451CEV level ⅤjCiT2F00699jnD

’W–ŸŚ–E“śŽî‚ÍŽîᇍŚ–E‚Ƀƒ‰ƒjƒ“‚đŠÜ‚Ț‚±‚Æ‚Ș‚ ‚èCT1 ‚Ć‚â‚⍂M†CT2 ‚Ć‚â‚â’áM†‚đŽŠ‚·‚±‚Æ‚Ș‚ ‚éiT2F00699jD

”S‰tüˆÛ“śŽî‚Í‹Ű–Œ‚ɉˆ‚Á‚čL‚Ș‚邱‚Æ‚Ș‘œ‚­CT2 ‚É‚Ä‚»‚̍L‚Ș‚è‚đ•]‰ż‚·‚邱‚Æ‚Ș‚Ć‚«‚émiT2F00672CEV level ⅤjCiT2F02154CEV level ⅤjnD

ƒKƒ“ƒOƒŠƒIƒ“‚⊊‰t•ï‰ŠCƒŠƒ“ƒpŠÇŽî‚ÍŠÜ—L‚·‚é‰t‘Ì‚đ”œ‰f‚”CT1 ‚Ć‹Ïˆê‚È’áM†CT2 ‚Ć‹Ïˆê‚Ì”ńí‚ɍ‚‚ąM†‚đŽŠ‚·D•Ó‰‚Ÿ‚Ż‚Ș‘ą‰e‚ł‚ê‚é‚œ‚ß”S‰t«‚ÌŽîá‡‚Æ‚ÍŠÓ•Ê‚Ć‚«‚émiTF00747jCiTF00268jCiTF00468CEV level ⅤjnD

•Čᎂ́Cˆê•””畆‚Æ‚ÌŠÔ‚É”ç‰șŽ‰–b‚Ì‘¶Ę‚”‚È‚ą•”ˆÊ‚Ș‚ ‚èC”í–Œ‚É‚æ‚è•Ó‰‚Ș–Ÿ—ĂƁC‘œÊ‚È“à—e•š‚É‚æ‚èT1 ‚Ć’á|‚M†CT2 ‚Ć‘S‘Ì“I‚ɍ‚M†‚Ì’†‚ɈꕔŠpŽż‚È‚Ç‚ÌŽc‹û‚É‚æ‚é’áM†‚đŽŠ‚·•”•Ș‚Ș‚ ‚éiT2F12409CEV level ⅤjD

ƒKƒ“ƒOƒŠƒIƒ“CŠŠ‰t•ï‰ŠCäFâ‹Ś–EŽîC‚Ń‚Ü‚ńŒ^‹Ś–EŽîiF‘f«ăO–ŃŒ‹ß«ŠŠ–Œ‰ŠjCMorton _ŒoŽîC‘«’êüˆÛŽîÇCƒOƒƒ€ƒXŽîᇂȂǂ͔­¶•”ˆÊ‚ÆMRIŠŒ©‚đ•č‚č‚é‚Ɛf’f‚É‚æ‚è—L—p‚Æ‚È‚émiTF00747jCiTF00268jCiTF00113jCiT2F02079jCiT2F01755jCiT2F00851CEV level ⅤjCiT2F02036jCiT2F00857CEV level ⅤjnD

y•¶@ŒŁz
1j T2F00850
Galant J, Marti-Bonmati L, Saez F et alFThe value of fat-suppressed T2 or STIR sequences in distinguishing lipoma from well-differentiated liposarcoma. Eur Radiol 2003G13i2jF337-343@mEV Level Ⅳn
2j T2F01538
Nishida J, Morita T, Ogose A et alFImaging characteristics of deep-seated lipomatous tumorsFintramuscular lipoma, intermuscular lipoma, and lipomalike liposarcoma. J Orthop Sci 2007G12i6jF533-541@mEV level Ⅴn
3j TF00623
Matsumoto K, Hukuda S, Ishizawa M et alFMRI findings in intramuscular lipomas. Skeletal Radiol 1999G28i3jF145-152@mEV level Ⅴn
4j T2F02140
Ritchie DA, Aniq H, Davies AM et alFHibernoma--correlation of histopathology and magnetic-resonance-imaging features in 10 cases. Skeletal adiol 2006G35i8jF579-589@mEV level Ⅴn
5j T2F01962
Moholkar S, Sebire NJ, Roebuck DJFRadiological-pathological correlation in lipoblastoma and lipoblastomatosis. Pediatr Radiol 2006G36i8jF851-856@mEV level Ⅴn
6j T2F00698
Lee JC, Gupta A, Saifuddin A et alFHibernomaFMRI features in eight consecutive cases. Clin Radiol 2006G61i12jF1029-1034@mEV level Ⅴn
7j T2F00932
Al-Qattan MM, Al-Lazzam AM, Al Thunayan A et alFClassification of benign fatty tumours of the upper limb. Hand Surg 2005G10i1jF43-59@mEV level Ⅴn
8j T2F00075
Shimose S, Sugita T, Kubo T et alFMajor-nerve schwannomas versus intramuscular schwannomas. Acta Radiol 2007G48i6jF672-677@mEV level Ⅴn
9j T2F00684
Koga H, Matsumoto S, Manabe J et alFDefinition of the target sign and its use for the diagnosis of schwannomas. Clin Orthop Relat Res 2007G464F224-229@mEV Level Ⅳn
10j T2F00519
Adani R, Baccarani A, Guidi E et alFSchwannomas of the upper extremityF diagnosis and treatment. Chir Organi Mov 2008G92i2jF85-88@mEV level Ⅴn
11j T2F00298
Wild AT, Raab P, Krauspe RFHemangioma of skeletal muscle. Arch Orthop Trauma Surg 2000G120i3-4jF139-143@mEV level Ⅴn
12j T2F01065
Wu JL, Wu CC, Wang SJ et alFImaging strategies in intramuscular haemangiomasFan analysis of 20 cases. Int Orthop 2007G31i4jF569-575@mEV level Ⅴn
13j T2F02141
Griffin N, Khan N, Thomas JM et alFThe radiological manifestations of intramuscular haemangiomas in adultsFmagnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol 2007G36i11jF1051-1059@mEV level Ⅴn
14j TF00284
Theumann NH, Bittoun J, Goettmann S et alFHemangiomas of the fingersF MR imaging evaluation. Radiology 2001G218i3jF841-847@mEV level Ⅴn
15j T2F00700
Alyas F, Lee J, Ahmed M et alFPrevalence and diagnostic significance of fluid-fluid levels in soft-tissue neoplasms. Clin Radiol 2007G62i8jF769-774G discussion 75@mEV level Ⅴn
16j TF00195
Bhimani MA, Wenz JF, Frassica FJFPigmented villonodular synovitisFkeys to early diagnosis. Clin Orthop Relat Res 2001G386F197-202@mEV level Ⅴn
17j TF01218
Hughes TH, Sartoris DJ, Schweitzer ME et alFPigmented villonodular synovitisFMRI characteristics. Skeletal Radiol 1995G24i1jF7-12@mEV level Ⅴn
18j TF00073
Gibbons CL, Khwaja HA, Cole AS et alFGiant-cell tumour of the tendon sheath in the foot and ankle. J Bone Joint Surg Br 2002G84i7jF1000-1003@mEV level Ⅴn
19j TF00167
Peh WC, Wong Y, Shek TW et alFGiant cell tumour of the tendon sheath of the handFa pictorial essay. Australas Radiol 2001G45i3jF274-280
20j TF00196
Gonzalez Della Valle A, Piccaluga F, Potter HG et alFPigmented villonodular synovitis of the hipF2- to 23-year followup study. Clin Orthop Relat Res 2001G388F187-199@mEV level Ⅴn
21j TF00539
Rochwerger A, Groulier P, Curvale G et alFPigmented villonodular synovitis of the foot and ankleFa report of eight cases. Foot Ankle Int 1999G22i9jF 587-590@mEV level Ⅴn
22j TF01241
Jelinek JS, Kransdorf MJ, Shmookler BM et alFGiant cell tumor of the tendon sheathFMR findings in nine cases. Am J Roentgenol 1994G162i4jF 919-922@mEV level Ⅴn
23j T2F01645
Durr HR, Stabler A, Maier M et alFPigmented villonodular synovitis. Review of 20 cases. J Rheumatol 2001G28i7jF1620-1630@mEV level Ⅴn
24j T2F00142
Walsh EF, Mechrefe A, Akelman E et alFGiant cell tumor of tendon sheath. Am J Orthop 2005G34i3jF116-121
25j T2F02107
Kitagawa Y, Ito H, Amano Y et alFMR imaging for preoperative diagnosis and assessment of local tumor extent on localized giant cell tumor of tendon sheath. Skeletal Radiol 2003G32i11jF633-638@mEV level Ⅴn
26j T2F00856
De Schepper AM, Hogendoorn PC, Bloem JLFGiant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions. Eur Radiol 2007G17i2jF499-502@mEV level Ⅴn
27j TF00848
Blacksin MF, Siegel JR, Benevenia J et alFSynovial sarcomaFfrequency of nonaggressive MR characteristics. J Comput Assist Tomogr 1997G21i5jF 785-789@mEV level Ⅴn
28j T2F00410
O'Sullivan PJ, Harris AC, Munk PLFRadiological features of synovial cell sarcoma. Br J Radiol 2008G81i964jF346-356@mEV level Ⅴn
29j T2F02037
Marzano L, Failoni S, Gallazzi M et alFThe role of diagnostic imaging in synovial sarcoma. Our experience. Radiol Med 2004G107i5-6jF533-540@mEV level Ⅴn
30j T2F02111
Nakanishi H, Araki N, Sawai Y et alFCystic synovial sarcomasFimaging features with clinical and histopathologic correlation. Skeletal Radiol 2003G 32i12jF701-707@mEV level Ⅴn
31j TF00451
Suh JS, Cho J, Lee SH et alFAlveolar soft part sarcomaFMR and angiographic findings. Skeletal Radiol 2000G29i12jF680-689@mEV level Ⅴn
32j T2F00699
Stacy GS, Nair LFMagnetic resonance imaging features of extremity sarcomas of uncertain differentiation. Clin Radiol 2007G62i10jF950-958
33j T2F00672
Manoso MW, Pratt J, Healey JH et alFInfiltrative MRI pattern and incomplete initial surgery compromise local control of myxofibrosarcoma. Clin Orthop Relat Res 2006G450F89-94@mEV level Ⅴn
34j T2F02154
Kaya M, Wada T, Nagoya S et alFMRI and histological evaluation of the infiltrative growth pattern of myxofibrosarcoma. Skeletal Radiol 2008G37i12jF 1085-1090@mEV level Ⅴn
35j TF00747
Llauger J, Palmer J, Monill JM et alFMR imaging of benign soft-tissue masses of the foot and ankle. Radiographics 1998G18i6jF1481-1498
36j TF00268
Maldjian C, Rosenberg ZSFMR imaging features of tumors of the ankle and foot. Magn Reson Imaging Clin N Am 2001G9i3jF639-657, Xii
37j TF00468
Sermon A, Gruwez JA, Lateur L et alFThe importance of magnetic resonance imaging in the diagnosis and treatment of diffuse lymphangioma. Acta Chir Belg 1999G99i5jF230-235@mEV level Ⅴn
38j T2F12409
Shibata T, Hatori M, Satoh T et alFMagnetic resonance imaging features of epidermoid cyst in the extremities. Arch Orthop Trauma Surg 2003G123i5jF 239-241@mEV level Ⅴn
39j TF00113
Bancroft LW, Peterson JJ, Kransdorf MJ et alFSoft tissue tumors of the lower extremities. Radiol Clin North Am 2002G40i5jF991-1011
40j T2F02079
Woertler KFSoft tissue masses in the foot and ankleFcharacteristics on MR imaging. Semin Musculoskelet Radiol 2005G9i3jF227-242
41j T2F01755
Shankman S, Kolla S, Beltran JFMR imaging of tumors and tumor-like lesions of the upper extremity. Magn Reson Imaging Clin N Am 2004G12i2jF 349-359
42j T2F00851
Horcajadas AB, Lafuente JL, de la Cruz Burgos R et alFUltrasound and MR findings in tumor and tumor-like lesions of the fingers. Eur Radiol 2003G13i4jF 672-685@mEV level Ⅴn
43j T2F02036
Bancroft LW, Peterson JJ, Kransdorf MJFImaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am 2008G46i6jF1093-1103, vii
44j T2F00857
Adams ME, Saifuddin AFCharacterisation of intra-articular soft tissue tumours and tumour-like lesions. Eur Radiol 2007G17i4jF950-958@mEV level Ⅴn

CQ 6
ƒ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚Ì—L—p«‚Í
—v–ń
Grade C
 
—ǁEˆ««f’fC•aŠúf’fC‰»Šw—Ă–@‚â•úŽËü—Ă–@‚ÌŒű‰Ê”»’è‚É‚š‚Ż‚é—L—p«‚Ș•ń‚ł‚ê‚Ä‚ą‚éD
y‰đ@àz

ƒ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚É‚æ‚é—ǁEˆ««‚ÌŠÓ•Ê‚ÉŠÖ‚”‚ẮC—L—p«‚Æ‚Æ‚à‚É‹U—z«C‹U‰A«‚Ș•ń‚ł‚ê‚Ä‚ą‚émiTF00722CEV level ⅤjCiTF00800CEV level ⅤjCiT2F12407CEV level ⅤjCiT2F12405CEV level Ⅴjn‚Ì‚ĆC‘gDŠw“I‚ÉŠm”F‚·‚é•K—v‚Ș‚ ‚éD

•úŽËüŽĄ—Ă‘OŒă‚Ƀ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚đŽÀŽ{‚·‚邱‚Æ‚ĆCWÏŒž­‚ÆŽîᇉ󎀂Ƃ̑ŠŠÖ‚đŽŠ‚”‚œ•ń‚Ș‚ ‚èC‚»‚Ì—L—p«‚ȘŽŠŽ‚ł‚ê‚Ä‚ą‚éiT2F12403CEV level ⅣjD‚Ü‚œ‰»Šw—Ă–@‚ÌŒű‰Ê”»’è‚É‚š‚Ż‚éƒ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚Ì—L—p«‚ȘŽŠŽ‚ł‚ê‚Ä‚ą‚émiT2F12405CEV level ⅤjCiT2F12406CEV level Ⅴjn‚ȘC‚±‚ê‚ç‚àŠŽŽó«C“ÁˆÙ«Cž“x‚ɂ΂ç‚‚«‚Ș‚ ‚éD

‘Œ‚̃Vƒ“ƒ`ƒOƒ‰ƒtƒB[‚Æ‚”‚āCƒKƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚Í“î•”Žîᇂɑ΂”‚ÄĆ‹ß‚Ć‚Í—p‚ą‚ç‚ê‚邱‚Æ‚Ș­‚È‚­CœƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚ÍŽîᇂ̍œ”玿‚ւ̐Z‚âCœ‚Ö‚Ì“]ˆÚ•a‘ƒ‚Ì“Ż’è‚É—L—p‚ƂȂ邱‚Æ‚Ș‚ ‚éD

y•¶@ŒŁz
1j TF00722
Sato O, Kawai A, Ozaki T et alF Value of thallium-201 scintigraphy in bone and soft tissue tumors. J Orthop Sci 1998G3i6jF297-303@mEV level Ⅴn
2j TF00800
Abe H, Terui S, Terauchi T et alFComparison of Tc-99m pertechnetate with Tl-201 and Ga-67 scintigraphy of malignant soft-tissue tumors. Clin Nucl Med 1997G22i1jF38-41@mEV level Ⅴn
3j T2F12407
Otsuka H, Terazawa K, Morita N et alFThallium-201 chloride scintigraphy in soft tissue tumors. J Med Invest 2009G56i3-4jF136-141@mEV level Ⅴn
4j T2F12405
Goto Y, Ihara K, Kawauchi S et alFClinical significance of thallium-201 scintigraphy in bone and soft tissue tumors. J Orthop Sci 2002G7i3jF304-312@mEV level Ⅴn
5j T2F12403
Choong PF, Nizam I, Ngan SY et alFThallium-201 scintigraphy-a predictor of tumour necrosis in soft tissue sarcoma following preoperative radiotherapy? Eur J Surg Oncol 2003G29i10jF908-915@mEV Level Ⅳn
6j T2F12406
Menendez LR, Fideler BM, Mirra JFThallium-201 scanning for the evaluation of osteosarcoma and soft-tissue sarcoma. A study of the evaluation and predictability of the histological response to chemotherapy. J Bone Joint Surg Am 1993G75i4jF526-531@mEV level Ⅴn

CQ 7
PET ŒŸž‚Ì—L—p«‚Í
—v–ń
Grade C
—ǁEˆ««f’fC•aŠúf’fC‰»Šw—Ă–@‚ÌŒű‰Ê”»’è‚ɑ΂”‚Ä‚Ì—L—p«‚Ș•ń‚ł‚ê‚Ä‚ą‚éD
y‰đ@àz

ˆ««ŽîᇍŚ–E‚Í‘B‚̃Gƒlƒ‹ƒM[Œč‚Æ‚”‚ăuƒhƒE“œ‚đ—˜—p‚”‚Ä‚ą‚邱‚Æ‚©‚çCƒuƒhƒE“œ‘ăŽÓ‚đ‰æ‘œ‰»‚·‚ê‚΁Cˆ««ŽîᇍŚ–E‚ÌŠˆ“źó‘Ô‚Ș‚í‚©‚邱‚Æ‚Ș‘œ‚ąDƒuƒhƒE“œ‚Æ‚æ‚­Ž—‚œ\‘ąŽź‚đŽ‚ÂFDGifluorodeoxyglucosej‚đĂ–Ź“à“Š—^‚”CFDG ‚Ì‘Ì“à•Ș•z‚đŽB‰e‚”C‘gD‚Ö‚ÌŽæ‚荞‚Ę‚đ•]‰ż‚·‚éDƒgƒŒ[ƒT[‚Æ‚”‚Ä18F ‚Ć•WŽŻ‚”‚œFDG ‚đ—p‚ą‚Ä—z“dŽq‚đŒŸo‚·‚éƒRƒ“ƒsƒ…[ƒ^’f‘wŽB‰e‹Zp‚ȘFDG-PET ‚Ć‚ ‚éDPET ‚ÆCT ‚đˆê‘̉»‚”‚œPET/CT ‚àŠJ”­‚ł‚êC—Œ‰æ‘œ‚đƒ\ƒtƒg“I‚ɏd‚ˍ‡‚í‚č‚œ—Z‡‰æ‘œ‚ȘŽć—Ź‚Æ‚È‚è‚‚‚ ‚éD

ƒVƒXƒeƒ}ƒeƒBƒbƒNƒŒƒrƒ…[‚É‚š‚ą‚āC—ǁEˆ««‚ÌŠÓ•Ê‚Ÿ‚Ż‚Ć‚Í‚È‚­C‚ˆ««‚ƒራ«‚ÌŠÓ•Ê‚É‚à—L—p‚Ć‚ ‚邱‚Æ‚ȘŽŠŽ‚ł‚ê‚Ä‚ą‚éiT2F05093CEV level ⅠjD‚Ü‚œC_ŒoüˆÛŽî‚ƈ««––œ_ŒoâŽîᇂƂ̊ӕʂÉSUV ’l‚Ș—L—p‚Ć‚ ‚邱‚Æ‚ȘŽŠŽ‚ł‚ê‚Ä‚ą‚émiT2F12401CEV level ⅤjCiT2F12404CEV level ⅤjnD‚”‚©‚”C“î•”“śŽîˆê”Ê‚É‚š‚ą‚Ä‚ÍSUV ’l‚ɂ΂ç‚‚«‚Ș‚ ‚èC—ǁEˆ««‚ÌŠÓ•Ê‚É‚Í“K‚ł‚È‚ą‘gDŒ^‚à‚ ‚éiT2F12402CEV level ⅤjD

‚Ü‚œCƒŠƒ“ƒpß“]ˆÚEœ“]ˆÚ‚ÌŒŸo‚É‚š‚ą‚Ä—D‚ê‚Ä‚ą‚é‚Æ‚Ì•ń‚Ș‚ ‚éiT2F08369CEV level ⅣjD

‚ˆ««“x“î•”“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚ÌŒű‰Ê”»’è‚Æ‚”‚āCSUV ’l‚Ș‘gD‰óŽ€—Š‚Æ‘ŠŠÖ‚·‚邱‚Æ‚Ș•ń‚ł‚ê‚Ä‚ą‚éiT2F05288CEV level ⅣjD‚Ü‚œ‰fŽž‚Ć‚ÌSUV ’l‚š‚æ‚яp‘O‰»Šw—Ă–@‘OŒă‚Ć‚ÌSUV ‰ș~•‚Æ—\Œă‚Ș‘ŠŠÖ‚·‚é‚Æ‚Ì•ń‚Ș‚ ‚émiT2F00692CEV level ⅣjCiT2F04823CEV level Ⅳjni‰»Šw—Ă–@Œű‰Ê”»’è‚ɂ‚ą‚Ä‚Í‘æ9 ÍCQ2 ‚àŽQÆjD

“î•”Žîᇂɑ΂·‚é—ǁEˆ««f’fC•aŠúf’fCÄ”­E“]ˆÚf’f‚É‚š‚ą‚㋁[ƒ`ƒ“ŒŸž‚Æ‚”‚Đ„§‚·‚é‚œ‚߂ɍĄŒă‚̃f[ƒ^‚Ì’~Ï‚Ș•K—v‚Ć‚ ‚éD

y•¶@ŒŁz
1j T2F05093
Bastiaannet E, Groen H, Jager PL et alFThe value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomasGa systematic review and meta-analysis. Cancer Treat Rev 2004G 30i1jF83-101@mEV level Ⅰn
2j T2F12401
Benz MR, Czernin J, Dry SM et alFQuantitative F18-fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign. Cancer 2010G116i2jF451-458@mEV level Ⅴn
3j T2F12404
Ferner RE, Golding JF, Smith M et alFm18Fn2-fluoro-2-deoxy-D-glucose positron emission tomographyiFDG PETjas a diagnostic tool for neurofibromatosis 1iNF1jassociated malignant peripheral nerve sheath tumoursiMPNSTsjFa long-term clinical study. Ann Oncol 2008G19i2jF 390-394@mEV level Ⅴn
4j T2F12402
Charest M, Hickeson M, Lisbona R et alFFDG PET/CT imaging in primary osseous and soft tissue sarcomasFa retrospective review of 212 cases. Eur J Nucl Med Mol Imaging 2009G36i12jF1944-1951@mEV level Ⅴn
5j T2F08369
Volker T, Denecke T, Steffen I et alFPositron emission tomography for staging of pediatric sarcoma patientsFresults of a prospective multicenter trial. J Clin Oncol 2007G25i34jF5435-5441@mEV Level Ⅳn
6j T2F05288
Benz MR, Czernin J, Allen-Auerbach MS et alFFDG-PET/CT imaging predicts histopathologic treatment responses after the initial cycle of neoadjuvant chemotherapy in high-grade soft-tissue sarcomas. Clin Cancer Res 2009G15i8jF2856-2863@mEV Level Ⅳn
7j T2F00692
Lisle JW, Eary JF, O'Sullivan J et alFRisk assessment based on FDG-PET imaging in patients with synovial sarcoma. Clin Orthop Relat Res 2009G467i6jF1605-1611@mEV Level Ⅳn
8j T2F04823
Schuetze SM, Rubin BP, Vernon C et alFUse of positron emission tomography in localized extremity soft tissue sarcoma treated with neoadjuvant chemotherapy. Cancer 2005G103i2jF339-348@mEV Level Ⅳn

‘æ‚TÍ@¶ŒŸ‚É‚æ‚éf’f

Clinical QuestionE„§ˆê——‚Ö


CQ 1
¶ŒŸ‚Ì•û–@‚ÆŠeX‚Ì—˜“_‚ÆŒ‡“_‚Í
—v–ń
Grade B
ó‹”‚ɉž‚¶‚ÄŽć‚ɐj¶ŒŸCŰŠJ¶ŒŸ‚đŽg‚ą•Ș‚Ż‚éDŰœ¶ŒŸ‚ÍŒÀ‚ç‚ê‚œó‹”‚Ć—p‚ą‚ç‚ê‚éD
y‰đ@àz

“î•”Žîᇂ̐¶ŒŸ•û–@‚́C①j¶ŒŸC②ŰŠJ¶ŒŸC③Űœ¶ŒŸ‚É•Ș—Ț‚ł‚ê‚éDŠeX‚É—˜“_‚ÆŒ‡“_‚Ș‚ ‚é‚Ì‚ĆCó‹”‚ɉž‚¶‚ÄŽg‚ą•Ș‚Ż‚é•K—v‚Ș‚ ‚éD

j¶ŒŸ‚Í‘gDf’f‚đŽć–Ú“I‚Æ‚”‚čs‚í‚ê‚éDĆ‹ß‚Ć‚Í’Ž‰č”g‰æ‘œCCTC‚Ü‚œ‚ÍMRI ‚đƒKƒCƒh‚É‚”‚čs‚€Žè‹Z‚ȘL‚Ü‚è‚‚‚ ‚émiT2F11483CEV level ⅤjCiT2F01166CEV level ⅤjCiT2F00057CEV level ⅤjnD‹ÇŠ–ƒŒ‰ș‚ÉŠO—ˆ‚ƍs‚ŠCŠłŽÒ‚ւ̐NP‚Ș­‚È‚­‘gDf’f‚Ș“Ÿ‚ç‚ê‚é‚Ì‚ĆL‚­—p‚ą‚ç‚ê‚Ä‚ą‚éiT2F12430CEV level ⅤjD‚”‚©‚”‘gDÌŽæ—ʂ͏­‚È‚­CŒo”ç“I‚ɍs‚í‚ê‚é‚Ì‚Ć“śŠá“I‚ÈŽîᇂ̊m”F‚Í‚Ć‚«‚žCŽž‚ɂ͐f’f‚É•s“KŰ‚ȃTƒ“ƒvƒ‹‚”‚©“Ÿ‚ç‚ê‚È‚ą‚±‚Æ‚à‚ ‚éD

ŰŠJ¶ŒŸ‚͔畆‚đŰŠJ‚”Žîá‡‚đ’ŒŽ‹‚”‚È‚Ș‚çŽîᇑgD‚̈ꕔ‚đÌŽæ‚·‚é•û–@‚ƁCˆê”Ê‚É‚Í‘gDf’f‚ɏ\•Ș—Ê‚ÌŽîᇑgD‚đÌŽæ‚·‚邱‚Æ‚Ș‰Â”\‚Ć‚ ‚éD”畆‚đŰŠJ‚”‚ÄŽîᇂ܂Ɛi“ü‚·‚é‚œ‚߁C‘Sg–ƒŒC˜’Ć–ƒŒC‚Ü‚œ‚Í“`’B–ƒŒ‚È‚Ç‚Ș•K—v‚È‚±‚Æ‚Ș‘œ‚ą‚ȘCp’†‚ɐv‘Źf’f‚Șs‚Š‚ê‚΁Cf’f‰Â”\‚È‘gD‚ȘÌŽæ‚Ć‚«‚œ‚©‚ÌŠm”F‚Ș‰Â”\‚Ć‚ ‚éD

Űœ¶ŒŸ‚ÍŽîᎁC‚Ü‚œ‚ÍŽîᇑS‘Ì‚đŰœ‚”‘gDf’f‚·‚é•û–@‚ƁC‚»‚Ì“K‰ž‚͐Td‚Ć‚È‚Ż‚ê‚΂Ȃç‚È‚ą‚Ì‚Ć–{ÍCQ3 ‚Ć•Ê‚Éq‚Ś‚éD

y•¶@ŒŁz
1j T2F11483
Hau A, Kim I, Kattapuram S et alFAccuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002G31i6jF349-353mEV level Ⅴn
2j T2F01166
Carrino JA, Khurana B, Ready JE et alFMagnetic resonance imaging-guided percutaneous biopsy of musculoskeletal lesions. J Bone Joint Surg Am 2007G 89i10jF2179-2187@mEV level Ⅴn
3j T2F00057
Narvani AA, Tsiridis E, Saifuddin A et alFDoes image guidance improve accuracy of core needle biopsy in diagnosis of soft tissue tumours? Acta Orthop Belg 2009G75i2jF239-244@mEV level Ⅴn
4j T2F12430
Strauss DC, Qureshi YA, Hayes AJ et alFThe role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 2010G102i5jF 523-529@mEV level Ⅴn

CQ 2
¶ŒŸ‚Ì’ˆÓ“_‚Í
—v–ń
Grade A
 
 
 
 
 
¶ŒŸ‚̐i“üŒo˜H‚́CŒă‚ÉŽîᇂƈꏏ‚ɐۏœ‚·‚é•K—v«‚Ș¶‚¶‚邱‚Æ‚đl—¶‚”‚жŒŸj‚ÌŽh“ü“_‚â”畆ŰŠJ‚Ì•”ˆÊ‚đŒˆ‚ßC‚ł‚ç‚Ɉȉș‚Ì“_‚đ…Žç‚”‚čs‚€D①”畆ŰŠJ‚đŽlŽˆ’·ŽČ‚ɉˆ‚Á‚Ä“ü‚êC②i“üŒo˜H‚Æ‚”‚ďd—v‚Ȑ_ŒoŒŒŠÇ‚Ì‹ß–T‚Í”đ‚ŻC③i“üŒo˜H‚Í‹ŰŠÔ‚Ć‚È‚­‹Ű“à‚ÉĘ’è‚”C④i“üŒo˜H‚Ì”ç‰ș‘gD‚â‹Ű‚Ì”—Ł‚͍ƏŹŒÀ‚ɂƂǂ߁C⑤¶ŒŸŒă‚ÉŒŒŽî‚Ș¶‚¶‚È‚ą‚æ‚€ŠmŽÀ‚ÉŽ~ŒŒ‚”C⑥ƒhƒŒ[ƒ“‚đ‚š‚­ê‡‚ɂ́C”畆ŰŠJăC‚ ‚é‚ą‚Í‚»‚̉„’·üă‚Ì‚·‚ź‹ß–T‚ɏo‚”C⑦–D‡j‚Í‚È‚é‚Ś‚­•‚đ‹·‚­Š|‚Ż‚éD
y‰đ@àz

j¶ŒŸCŰŠJ¶ŒŸC‚ą‚ž‚ê‚Ć‚à¶ŒŸ‚̐i“üŒo˜H‚ÍŽîᇂɉ˜ő‚ł‚ê‚éD‚æ‚Á‚жŒŸŒă‚̍L”͐ۏœ‚Ƃ́C‚±‚̐i“üŒo˜H‚àŽîᇂƈꏏ‚ɐۏœ‚·‚é•K—v«‚Ș¶‚¶‚邱‚Æ‚đl—¶‚”‚жŒŸj‚ÌŽh“ü“_‚â”畆ŰŠJ‚Ì•”ˆÊ‚đŒˆ‚ß‚È‚Ż‚ê‚΂Ȃç‚È‚ąD¶ŒŸ‚Șs‚í‚ê‚œÇ—á‚Ì‚€‚ż19.3% ‚ȘC¶ŒŸ‚É”ș‚€‡•čÇ‚É‚æ‚è‚»‚ÌŒă‚ÌŽîᇂ̎Ą—Ă‚É‚š‚ą‚ĉœ‚ç‚©‚̉e‹ż‚đŽó‚ŻC¶ŒŸ‚Ɛf’f‚ł‚ê‚œ597 —á’†18 —á‚Ș–{—ˆ•s•K—v‚ÈŠłŽˆ‚ÌŰ’f‚đŽó‚Ż‚é‚ÉŽŠ‚Á‚œ‚Æ‚ł‚ê‚Ä‚ą‚éiT2F12426CEV level ⅤjD¶ŒŸ‚ÍŽîᇂ̎èp‚ɐž’Ê‚”‚œˆăŽt‚Șs‚€‚±‚Æ‚Ș–]‚Ü‚”‚ąD

ŰŠJ¶ŒŸ‚đs‚€ê‡‚Ì’ˆÓ“_‚Æ‚”‚āC①”畆ŰŠJ‚đ”畆‚â“î•”‘gD‚̍Čš‚Ș—eˆŐ‚ÈŽlŽˆ’·ŽČ‚ɉˆ‚Á‚Ä“ü‚êi}1jmiT2F12424jCiT2F12425jnC②ŽîᇍŚ–E‚̉˜ő‚đ”đ‚Ż‚é‚œ‚ߐi“üŒo˜H‚Æ‚”‚ďd—v‚Ȑ_ŒoŒŒŠÇ‚Ì‹ß–T‚Í”đ‚ŻmiT2F12424jCiT2F12425jnC③‹ŰŠÔ‚đi“üŒo˜H‚Æ‚·‚é‚Æ2 ‚Â‚Ì‹Ű‚đ‰˜ő‚·‚邱‚Æ‚É‚È‚é‚Ì‚Ć‹Ű“à‚ÉĘ’è‚”iT2F12424jC④i“üŒo˜H‚Ì”ç‰ș‘gD‚â‹Ű‚Ì”—Ł‚͍ƏŹŒÀ‚É‚Æ‚Ç‚ß‚ÄŽîᇔ햌‚É’B‚·‚é‚æ‚€‚É‚”C⑤oŒŒ‚É‚æ‚錌Žî‚̍L‚Ș‚è‚àŽîᇍŚ–E‰˜ő‚ÌŒŽˆö‚É‚È‚é‚Ì‚ĆŠmŽÀ‚ÉŽ~ŒŒ‚”miT2F12424jCiT2F12425jnC⑥ƒhƒŒ[ƒ“‚đ‚š‚­ê‡‚ɂ́C”畆ŰŠJă‚ ‚é‚ą‚Í‚»‚̉„’·üă‚Ì‚·‚ź‹ß–T‚ɏo‚”iT2F12424jC⑦–D‡j‚Í‚È‚é‚Ś‚­•‚đ‹·‚­Š|‚Ż‚éi}2jC‚È‚Ç‚Ș‚ ‚°‚ç‚ê‚éD

}1 ”畆ŰŠJ‚Ì•ûŒü

}1”畆ŰŠJ‚Ì•ûŒü
L”͐ۏœŒă‚ɔ畆‚â“î•”‘gD‚̍Čš‚Ș—eˆŐ‚ÈŽlŽˆ’·
ŽČ‚ɉˆ‚Á‚Ä“ü‚ê‚邱‚Æ‚Șd—v‚Ć‚ ‚éiT2F12424jD

}2 ŰŠJ¶ŒŸŽž‚̃hƒŒ[ƒ“‚̈ʒu‚Æ–D‡‚Ì’ˆÓ“_

}2ŰŠJ¶ŒŸŽž‚̃hƒŒ[ƒ“‚̈ʒu‚Æ–D‡‚Ì’ˆÓ“_
ƒhƒŒ[ƒ“‚Í“ü‚ê‚È‚ą‚©i¶’[jCŰŠJ‘n‚É‚š‚­‚©i¶‚©‚ç2 ”ԖځjCŰŠJü‰„’·ă‚Ì‚·‚ź‹ß–T‚É’u‚­i¶‚©‚ç3 ”Ԗځj‚æ‚€‚É‚·‚éD–D‡Ž…‚đ•L‚­Š|‚Ż‚œ‚èi‰E‚©‚ç3 ”ԖځjCƒhƒŒ[ƒ“‚đŰŠJü‚©‚ç—Ł‚ê‚œŠ‚É’u‚­i‰E‚©‚ç2 ”ԖڂƉE’[j‚Ì‚ÍŽîᇂ̉˜ő‚ȘL‚Ș‚é‰Â”\«‚Ș‚‚­•s“KŰ‚Ć‚ ‚éD

‘Œ‚Ì’ˆÓ“_‚Æ‚”‚ẮC•a—f’f‚É“K‚”‚œŽîᇑgD‚đÌŽæ‚·‚é‚œ‚߁C‰æ‘œŠŒ©‚đ‚à‚Ƃɉ󎀑gD‚⌌Žî‚Ș—\‘z‚ł‚ê‚é•”ˆÊ‚đ”đ‚Ż‚é‚±‚Æ‚Ș•K—v‚Ć‚ ‚éD‚Ü‚œj¶ŒŸ‚Ƃ͐¶ŒŸj‚ĆŽîᇂđŠŃ‚ą‚Ä‚”‚Ü‚í‚È‚ą‚æ‚€‚É’ˆÓ‚·‚éDŽîᇂɑ΂”j‚đ[‚­“ü‚ê‚·‚Ź‚é‚ÆŽîᇂđ[•”‚Ö”dŽí‚·‚邱‚Æ‚Æ‚È‚éi}3jD“Ż—l‚ɋǏŠ–ƒŒ–ò‚đŽüˆÍ‚ɐZ‚ł‚č‚鎞‚É‚àCj‚ȘŽîᇂɓü‚ç‚È‚ą‚æ‚€‚ɐS‚Ș‚Ż‚éD

Űœ¶ŒŸ‚Ć‚Ì’ˆÓ“_‚Í–{ÍCQ3 ‚Əq‚Ś‚éD

}3 j¶ŒŸŽž‚Ì’ˆÓ“_

}3j¶ŒŸŽž‚Ì’ˆÓ“_
Žîᇂɑ΂”j‚đ[‚­“ü‚ê‚·‚Ź‚é‚ÆŽîᇂđ[•”‚Ö”dŽí‚·‚邱‚Æ‚Æ‚È‚éD

y•¶@ŒŁz
1j T2F12426
Mankin HJ, Mankin CJ, Simon MAFThe hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am 1996G78i5jF656-663@mEV level Ⅴn
2j T2F12424
Bickels J, Jelinek JS, Shmookler BM et alFBiopsy of musculoskeletal tumors. Current concepts. Clin Orthop Relat Res 1999G368F212-219
3j T2F12425
Scarborough MTFThe biopsy. Instr Course Lect 2004G53F639-644

CQ 3
Űœ¶ŒŸ‚Ì“K‰ž‚Í
—v–ń
Grade B
 
 
 
ˆÈ‰ș‚ÌđŒ‚Ș‚»‚ë‚Á‚Ä‚ą‚éê‡‚ȘŒŽ‘„‚Ć‚ ‚éD①‘ć‚«‚ł‚ȘjC‚Ü‚œ‚͐ۊJ¶ŒŸ‚đs‚€‚ɂ͏Ź‚ł‚·‚Ź‚邱‚Ɓi2 `3cm ‚æ‚èŹ‚ł‚ą‚±‚ƁjC②”ç‰ș‚É‚ ‚邱‚ƁC③d—v‚ÈŒŒŠÇ_Œo‚È‚Ç‚Æ‚Í—Ł‚ê‚Ä‚ą‚āCŰœ¶ŒŸŽž‚É‚±‚ê‚ç‚đ”—Ł‚·‚é•K—v‚Ș‚È‚ą‚±‚ƁC④ MRI ‚Ȃǂ̏p‘O‰æ‘œŒŸž‚Șs‚í‚ê‚Ä‚ą‚邱‚ƁD
y‰đ@àz

Űœ¶ŒŸ‚Æ‚ÍŽîᎁC‚Ü‚œ‚ÍŽîᇑS‘Ì‚đŰœ‚”‚Ä•a—‘gDf’f‚đs‚€¶ŒŸ•û–@‚Ć‚ ‚éD‚±‚ê‚Ƃ͈قȂèC\•Ș‚ȏp‘O‰æ‘œŒŸž‚đ‚č‚žC—ǐ«‚Ć‚ ‚ë‚€‚Æ‚Ì—\‘z‚Ì‚à‚ƂɁCŰœ‰‚É”z—¶‚·‚邱‚Æ‚È‚­s‚í‚ê‚é‚à‚̂́gunplanneditotaljexcisionh ‚ƌĂ΂êmiT2F12428CEV level ⅤjCiT2F12427CEV level ⅤjnC24 `60“‚̏Ǘá‚Ć“śŠá“IC‚Ü‚œ‚Í‘gDŠw“I‚ÈŽîᇂ̎c‘¶‚Ș•ń‚ł‚ê‚Ä‚š‚èiT2F12427CEV level ⅤjCŒ”‚ɐT‚Ț‚Ś‚«‚Ć‚ ‚éDunplanned excision Œă‚Ƃ́C”çŰ•”‚ÆŽîᇎü•Ó‘gD‚Ö‚ÌŽîᇂ̉˜ő‚Șl‚Š‚ç‚ê‚é‚œ‚߁C’ljÁL”͐ۏœ‚͈͈̔͂êŠú“I‚ȍL”͐ۏœ‚ɔ䂌‚æ‚èL”Í‚È‚à‚Ì‚Æ‚È‚èC‚”‚΂”‚Δç•Ù‚âA”ç‚đ—v‚”CŽž‚É‚Í‹@”\áŠQ‚Ș”đ‚Ż‚ç‚ê‚È‚ąmiT2F12428CEV level Ⅴ jCiT2F12427CEV level Ⅴ jCiT2F12429CEV level ⅤjnD

ˆÈă‚©‚çCŰœ¶ŒŸ‚́Cj¶ŒŸ‚ÆŰŠJ¶ŒŸ‚Șs‚Š‚žC‚©‚ۏœ¶ŒŸ‚Ćˆ««‚Æ”»–Ÿ‚”‚œŽž‚ɒljÁL”͐ۏœ‚đs‚ą‚â‚·‚ą•”ˆÊ‚ÌŽîᇂɓK‰ž‚Ș‚ ‚é‚ƍl‚Š‚ç‚ê‚éD‚æ‚è‹ï‘Ì“I‚È“K‰žđŒ‚đŽŠ‚·‚ƁC①‘ć‚«‚ł‚ȘjC‚Ü‚œ‚͐ۊJ¶ŒŸ‚đs‚€‚ɂ͏Ź‚ł‚·‚Ź‚邱‚Ɓi2 `3 cm ‚æ‚èŹ‚ł‚ą‚±‚ƁjC②”ç‰ș‚É‚ ‚邱‚ƁC③d—v‚ÈŒŒŠÇ_Œo‚È‚Ç‚Æ‚Í—Ł‚ê‚Ä‚ą‚Đۏœ¶ŒŸŽž‚É‚±‚ê‚ç‚đ”—Ł‚·‚é•K—v‚Ș‚È‚ą‚±‚ƁC④MRI ‚Ȃǂ̏p‘O‰æ‘œŒŸž‚Șs‚í‚ê‚Ä‚ą‚邱‚ƁC‚Ì4 ‚‚Ƃ ‚éD

Űœ¶ŒŸ‚É‚š‚ą‚Ä‚à–{ÍCQ2 ‚Əq‚Ś‚œŰŠJ¶ŒŸŽž‚Ì’ˆÓŽ–€‚Ì‘ć•”•Ș‚Ș‚»‚Ì‚Ü‚Ü“K‰ž‚ł‚ê‚éD‚·‚È‚í‚żC①”畆ŰŠJ‚ÍŽlŽˆ’·ŽČ‚ɉˆ‚Á‚Ä“ü‚êmiT2F12424jCiT2F12425jnC②i“üŒo˜H‚Æ‚”‚ďd—v‚Ȑ_ŒoŒŒŠÇ‚Ì‹ß–T‚Í”đ‚ŻmiT2F12424jCiT2F12425jnC③i“üŒo˜H‚Ì”ç‰ș‘gD‚â‹Ű‚Ì”—Ł‚͍ƏŹŒÀ‚ɂƂǂ߁C④ŒŒŽî‚Ș¶‚¶‚È‚ą‚æ‚€‚ÉŠmŽÀ‚ÉŽ~ŒŒ‚”miT2F12424jCiT2F12425jnC⑤ƒhƒŒ[ƒ“‚đ‚š‚­ê‡‚ɂ́C”畆ŰŠJă‚ ‚é‚ą‚Í‚»‚̉„’·üă‚Ì‚·‚ź‹ß–T‚ɏo‚”iT2F12424jC⑥–D‡j‚Í‚È‚é‚Ś‚­•‚đ‹·‚­Š|‚Ż‚é‚æ‚€‚É‚·‚邱‚Æ‚È‚Ç‚Ć‚ ‚éD‚Ü‚œˆ««Žîᇂđ‹^‚€ê‡‚́C‹ÇŠ–ƒŒ‚Í”đ‚Ż‘Sg–ƒŒ‰șC‚Ü‚œ‚Í“`’B–ƒŒ‰ș‚ɍs‚€‚±‚Æ‚Ș–]‚Ü‚”‚ąD

y•¶@ŒŁz
1j T2F12428
Giuliano AE, Eilber FRFThe rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. J Clin Oncol 1985G3i10jF 1344-1348@mEV level Ⅴn
2j T2F12427
Chandrasekar CR, Wafa H, Grimer RJ et alFThe effect of an unplanned excision of a soft-tissue sarcoma on prognosis. J Bone Joint Surg Br 2008G90i2jF203-208@mEV level Ⅴn
3j T2F12429
Manoso MW, Frassica DA, Deune EG et alFOutcomes of re-excision after unplanned excisions of soft-tissue sarcomas. J Surg Oncol 2005G91i3jF153-158@mEV level Ⅴn
4j T2F12424
Bickels J, Jelinek JS, Shmookler BM et alFBiopsy of musculoskeletal tumorsCurrent concepts. Clin Orthop Relat Res 1999G368F212-219
5j T2F12425
Scarborough MTFThe biopsy. Instr Course Lect 2004G53F639-644

CQ 4
•a—‘gD•W–{’ńo‘‚̏‘‚«•û‚Í
—v–ń
Grade I
 
①”N—îC②«C③•”ˆÊC④œë•aŠúŠÔC⑤‘‘ć‚̃Xƒs[ƒhC⑥‘ć‚«‚łC⑦[‚łC⑧‰æ‘œf’f–Œ‚È‚Ç‚Ș•K{‚̏î•ń‚Ć‚ ‚éD
y‰đ@àz

“î•”Žîᇂ̕a—‘gD•W–{’ńo‘‚É•K‚ž‹LÚ‚·‚Ś‚«8 €–Ú‚đˆÈ‰ș‚É‰Óđ‘‚«‚ĆŽŠ‚·D‚±‚ê‚ç‚Í•a—ˆă‚Ș•a—f’f‚·‚éÛ‚É•K{‚̏î•ń‚Ć‚ ‚éD

①”N—î
②«
③•”ˆÊ
④œë•aŠúŠÔ
⑤‘‘ć‚̃Xƒs[ƒh
⑥‘ć‚«‚ł
⑦[‚łi”ç‰șC‚Ü‚œ‚Í‹Ű“à‚Ȃǁj
⑧‰æ‘œf’f–Œ

‚Ù‚©‚ÉŠY“–‚·‚ê‚΋LÚ‚”‚œ‚Ù‚€‚Ș‚æ‚ą‚ÆŽv‚í‚ê‚鎖€‚đ—ń‹“‚·‚é‚ƁC’ɂʁC_Œo–ƒáƒCŠO‚Æ‚ÌŠÖ˜A«CTinel signCŠÖß‚âäFCŒŒŠÇ‚Ƃ̘A‘±«C‰”­‚Ü‚œ‚͍Ĕ­‚©CŠà‚ÌŠù‰—đCƒJƒtƒFƒIƒŒ”Á‚È‚Ç‚Ì”ç]‚Ì—L–łCÎŠD‰»‚Ì—L–łCp‘O‚̉»Šw—Ă–@‚â•úŽËüŽĄ—Ă‚Ì—L–ł‚È‚Ç‚Ș‚ ‚°‚ç‚ê‚éD

Žèp•W–{‚̏ꍇ‚ɂ͏ă‹L‚̍€–Ú‚Ì‚Ù‚©‚ÉŠ„–ʂ̃XƒPƒbƒ`‚âŽÊ^‚đ‰Á‚Š‚œ‚Ù‚€‚Ș•a—ˆă‚Í—‰đ‚”‚â‚·‚ąDŒŒŠÇ_Œo‚Ȃǂւ̐Z‚Ș‚ ‚é‚©‚Ç‚€‚©CŰœ”͈͂Ș\•Ș‚Ć‚ ‚Á‚œ‚©‚Ç‚€‚©‚ȂǁC—Տ°‚Ć–â‘è‚É‚È‚Á‚œ•”ˆÊ‚Í‚±‚̃XƒPƒbƒ`ă‚É–Ÿ‹L‚”‚œ‚Ù‚€‚Ș‚æ‚ąD‚Ć‚«‚ê‚Εa—ˆă‚Ș‘gD•W–{‚É‚·‚é•”ˆÊ‚đ‘I‘đ‚·‚éuŰ‚èo‚”v‚É—§‚ż‰ï‚Š‚ê‚΂æ‚è‚æ‚ąŒŸ“ą‚Șs‚Š‚éD‚Ć‚«‚ ‚Ș‚Á‚œ•a—‘gD•W–{‚ÍŠO‰È•a—ˆă‚ƈꏏ‚ÉŠÏŽ@‚·‚é‚Ì‚Ș—‘z‚Ć‚ ‚ë‚€D‚à‚”‚»‚ê‚Ș‚Ć‚«‚È‚­‚Ä‚à•W–{‚đ’ńo‚”‚œˆăŽt‚́C•a—f’f•ń‘‚đŒ©‚È‚Ș‚ç•a—‘gD•W–{‚đŒŸ‹Ÿ‚·‚Ś‚«‚Ć‚ ‚éD‹^–â“_‚Ș‚ ‚ê‚΁C•a—ˆă‚Æ’ŒÚ‹Š‹c‚·‚é‚æ‚€‚ɐS‚Ș‚Ż‚œ‚ąD


‘æ‚UÍ@•ȘŽq¶•šŠw“If’f

Clinical QuestionE„§ˆê——‚Ö


CQ 1
f’f‚É—L—p‚ȖƉu‘gD‰»Šw“IŒŸž‚Í
—v–ń
Grade B
 
–Ɖu‘gD‰»Šw“IŒŸž‚́C“î•”Žîᇂ̊ӕʂ̂œ‚ß‚É—L—p‚È‚à‚Ì‚à‚ ‚é‚ȘC•K‚ž‚”‚à“ÁˆÙ“I‚Ć‚È‚ą‚±‚Æ‚đ”O“Ș‚É’u‚ą‚Ä”»’f‚·‚é•K—v‚Ș‚ ‚éD
y‰đ@àz

–Ɖu‘gD‰»Šw“If’f‚ÉŽg—p‚ł‚ê‚éŽć‚ȃ}[ƒJ[‚Æ“î•”Žîᇂ̊֘A‚đ‚Ü‚Æ‚ß‚é‚Æ•\1 ‚Ì‚æ‚€‚É‚È‚éD‚œ‚Ÿ‚”C•a—‘gDf’f‚ƈê’v‚”‚È‚ą‚à‚Ì‚à­‚È‚­‚È‚ą‚Ì‚ĆC‚ ‚­‚Ü‚Ć•a—‘gDf’f‚̕⏕‚Æ‚”‚Ä—p‚ą‚é‚Ś‚«‚Ć‚ ‚éD

ă”琫ŽîᇂƔńă”琫‚Ì“î•”ŽîᇂƂ̊ӕʂɂÍvimentin ‚âcytokeratinCEMA ‚È‚Ç‚Ș—p‚ą‚ç‚ê‚邱‚Æ‚Ș‘œ‚ąDVimentin ‚Í‘œ‚­‚Ì“î•”ŽîᇂȘ—z«‚đ’æ‚”Că”琫ŽîᇂƂ͉A«‚Æ‚È‚éDCytokeratin ‚ÆEMA ‚͏ă”琫ŽîᇂƗz«‚É‚È‚é‚ȘC“î•”ŽîᇂƂ͏ă”ç—l‚̐«Ši‚đ‚à‚ŠŠ–Œ“śŽîC—Ță”ç“śŽî‚Ș—z«‚đ’æ‚”‚â‚·‚ąD

‹ŰŒŽ«‘gD‚̃}[ƒJ[‚Æ‚”‚Ä‚ÍdesminCmyoglobinCmyogeninCMyoD1Cƒż-smooth muscle actinCHHF-35 ‚È‚Ç‚Ș—p‚ą‚ç‚ê‚éDDesminCHHF-35 ‚͉Ą–ä‹ŰC•œŠŠ‹Ű‚Ì—ŒŽÒ‚Ć—z«‚Æ‚È‚èC•œŠŠ‹Ű“śŽî‚≥–ä‹Ű“śŽîC—ǐ«‚Ì•œŠŠ‹ŰŽîCŒ‹ß«‹Ű–Œ‰Š‚È‚Ç‚Ć‚à—z«‚ƂȂ邱‚Æ‚Ș‘œ‚ąDmyogeninCMyoD1Cmyoglobin ‚͉Ą–ä‹Ű‚É“ÁˆÙ“I‚ȃ}[ƒJ[‚ƁC“Á‚Émyogenin ‚͉Ą–ä‹Ű“śŽî‚ĆŠŽ“x‚Æ“ÁˆÙ«‚Ș‚‚­f’f‚É—L—p‚Ć‚ ‚éiT2F12433CEV level ⅣjDƒż -smooth muscle actin ‚Í•œŠŠ‹Ű‚É“ÁˆÙ“I‚ȃ}[ƒJ[‚Ć‚ ‚é‚ȘCƒOƒƒ€ƒXŽîᇁiTF00927CEV level Ⅴj‚Ć‚à—z«‚ɂȂ邱‚Æ‚Ș‘œ‚ąD

ŒŒŠÇ“à”çŒnƒ}[ƒJ[‚Ć‚ÍFactor ⅧCCD34CCD31 ‚È‚Ç‚Ș—p‚ą‚ç‚ê‚éDŒŒŠÇŽîCŒŒŠÇ“à”çŽîCŒŒŠÇ“śŽî‚È‚Ç‚Ć—z«‚É‚È‚é‚à‚Ì‚Ș‘œ‚ą‚ȘCCD34 ‚Í—Č‹N«”畆üˆÛ“śŽîiT2F12431CEV level ⅤjCŒÇĘ«üˆÛ«ŽîᇂȂǂ̐üˆÛ«ŽîᇁiT2F12435CEV level Ⅴj‚âC—Ță”ç“śŽîC_ŒoâŽîC_ŒoüˆÛŽî‚È‚Ç‚Ć‚à—z«‚ɂȂ邱‚Æ‚Ș‘œ‚ąD

_ŒoŒnƒ}[ƒJ[‚Æ‚”‚Ä‚ÍS-100 proteinCsynaptophysinCNSE ‚È‚Ç‚Ș—p‚ą‚ç‚ê‚é‚ȘCS-100 protein ‚͐_ŒoâŽîC_ŒoüˆÛŽîCˆ««––œ_ŒoâŽîᇂȂǂ̐_ŒoŒŽ«Žîᇂ̑Œ‚É’W–ŸŚ–E“śŽîCŽ‰–b“śŽîC‰Ą–ä‹Ű“śŽîCŠŠ–Œ“śŽî‚È‚Ç‚Ć‚à—z«‚ƂȂ邱‚Æ‚Ș‚ ‚éDSynaptophysinCNSE ‚͍œŠO«Ewing “śŽî‚Ć—z«‚Æ‚È‚éD

‚»‚Ì‘Œ‚̃}[ƒJ[‚Æ‚”‚ẮCHMB-45 ‚Ș’W–ŸŚ–E“śŽî‚Ć—z«‚ɂȂ邱‚Æ‚Ș‘œ‚ąiTF00457CEV level ⅤjDMIC2iCD99j‚ÍEwing “śŽîC‰Ą–ä‹Ű“śŽîCŠŠ–Œ“śŽî‚Ć—z«‚É‚È‚é‚à‚Ì‚Ș‚ ‚éDBcl-2 ‚Í“ÁˆÙ“I‚Ć‚Í‚È‚ą‚à‚Ì‚ÌŠŠ–Œ“śŽî‚âŒÇĘ«üˆÛ«ŽîᇁC—Č‹N«”畆üˆÛ“śŽî‚Ć—z«‚Ć‚ ‚邱‚Æ‚Ș‘œ‚ąmiT2F12435CEV level ⅤjCiT2F03174CEV level ⅤjnDŠŠ–Œ“śŽî‚Ƃ́C‹ß”NTLE1 ‚Ș‚±‚ê‚ç‚̃}[ƒJ[‚æ‚è‚àŠŽ“xC“ÁˆÙ“x‚Ș‚‚ą‚Æ‚Ì•ń‚Ș‚È‚ł‚ê‚Ä‚ą‚éiT2F12437CEV level Ⅴj

•\1 Žć‚È“î•”“śŽî‚Ɛf’f“IˆÓ‹`‚Ì‘ć‚«‚ąƒ}[ƒJ[

‰Ą–ä‹Ű“śŽî

desminCmyogeninCMyoD1CS-100 protein

•œŠŠ‹Ű“śŽî

desminCƒż -smooth muscle actinCHHF-35

ˆ««––œ_ŒoâŽîá‡

S100 protein

ŒŒŠÇ“śŽî

Factor ⅧCCD34CCD31

ŠŠ–Œ“śŽî

cytokeratinCEMACS-100 proteinCBcl-2CTLE1

œŠO«Ewing Žîá‡

MIC2CsynaptophysinCNSE

—Č‹N«”畆üˆÛ“śŽî

CD34CBcl-2

’W–ŸŚ–E“śŽî

HMB-45CS-100 protein

—Ță”ç“śŽî

cytokeratinCEMACvimentinCCD34

ŒÇĘ«üˆÛ«Žîá‡

CD34CBcl-2

y•¶@ŒŁz
1j T2F12433
Cessna MH, Zhou H, Perkins SL et alFAre myogenin and myoD1 expression specific for rhabdomyosarcoma? A study of 150 cases, with emphasis on spindle cell mimics. Am J Surg Pathol 2001G25i9jF1150-1157@mEV Level Ⅳn
2j TF00927
Hatori M, Aiba S, Kato M et alFExpression of CD34 in glomus tumors. Tohoku J Exp Med 1997G182i3jF241-247@mEV level Ⅴn
3j T2F12431
Abenoza P, Lillemoe TFCD34 and factor XⅢa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans. Am J Dermatopathol 1993G15i5jF429-434@mEV level Ⅴn
4j T2F12435
Hasegawa T, Matsuno Y, Shimoda T et alFFrequent expression of bcl-2 protein in solitary fibrous tumors. Jpn J Clin Oncol 1998G28i2jF86-91@mEV level Ⅴn
5j TF00457
De Beuckeleer LH, De Schepper AM, Vandevenne JE et alFMR imaging of clear cell sarcomaimalignant melanoma of the soft partsjFa multicenter correlative MRI-pathology study of 21 cases and literature review. Skeletal Radiol 2000G29i4jF187-195@mEV level Ⅴn
6j T2F03174
Suster S, Fisher C, Moran CAFExpression of bcl-2 oncoprotein in benign and malignant spindle cell tumors of soft tissue, skin, serosal surfaces, and gastrointestinal tract. Am J Surg Pathol 1998G22i7jF863-872@mEV level Ⅴn
7j T2F12437
Terry J, Saito T, Subramanian S et alFTLE1 as a diagnostic immunohistochemical marker for synovial sarcoma emerging from gene expression profiling studies. Am J Surg Pathol 2007G31i2jF240-246@mEV level Ⅴn

CQ 2
f’f‚É—L—p‚Ȉâ“`Žqf’f‚Í
—v–ń
Grade B
 
 
 
 
ŠŠ–Œ“śŽî‚⍜ŠO«Ewing “śŽîC–E‘ƒŒ^‰Ą–ä‹Ű“śŽî‚È‚ÇŽîᇓÁˆÙ“I‚ȐőF‘Ì“]À‚Æ‚»‚ê‚É”ș‚€—Z‡ˆâ“`Žq‚Ș‘¶Ę‚·‚éŽîᇂƂ́C‚»‚ê‚ç‚ÌŒŸo‚͊ӕʐf’f‚É—L—p‚Ć‚ ‚éDˆ««‚đ‹^‚€ê‡‚É‚Í—Z‡ˆâ“`Žq‚ÌŒŸo‚Ì‚œ‚߂ɐ¶ŒŸŽž‚É“€Œ‹•W–{‚đ•Û‘¶‚”‚Ä‚š‚­‚±‚Æ‚Ș–]‚Ü‚”‚ąD‚”‚©‚”Žè‹Z“I‚È–â‘è‚â—Z‡ˆâ“`Žq‚Ì–ą’m‚Ì•ÏˆÙ‚È‚Ç‚Ć‹U—z«‚â‹U‰A«‚Æ‚È‚é‰Â”\«‚Ș‚ ‚é‚œ‚߁CHematoxylin-EosiniHEjőF‚â–Ɖu‘gD‰»Šw“IŒŸž‚ÌŒ‹‰Ê‚È‚Ç‚àŠÜ‚ß‚Ä‘‡“I‚ɐf’f‚đ‚·‚é•K—v‚Ș‚ ‚éD
y‰đ@àz

ŠŠ–Œ“śŽîCœŠO«Ewing “śŽî‚â–E‘ƒŒ^‰Ą–ä‹Ű“śŽî‚È‚Ç‚Ć‚ÍCŽîᇓÁˆÙ“I‚ȐőF‘Ì“]À‚Ì‘¶Ę‚Ș’m‚ç‚ê‚Ä‚ą‚éDőF‘Ì“]À‚ÌŒ‹‰Ê‚Æ‚”‚悶‚é—Z‡ˆâ“`Žq‚à“Ż—l‚ÉŽîᇓÁˆÙ“I‚Ć‚ ‚邱‚Æ‚©‚çCHE őF‚â–Ɖu‘gD‰»ŠwŒŸž‚Ƃ͐f’f‚Șą“ï‚ȏǗá‚É‚š‚ą‚āC‚±‚ê‚ç‚đŒŸo‚·‚éˆâ“`Žqf’f‚Í—L—p‚Ć‚ ‚éDŽć‚È“î•”ŽîᇂƐf’f“IˆÓ‹`‚Ì‘ć‚«‚ąőF‘Ì“]À‚š‚æ‚Ń—Z‡ˆâ“`Žq‚đ‚Ü‚Æ‚ß‚é‚Æ•\1 ‚Ì‚æ‚€‚É‚È‚éD

őF‘Ì‘ŠŒĘ“]À‚đŒŸo‚·‚é‚œ‚߂̐őF‘̉đÍ‚É‚ÍG-band –@CSpectral KaryotypingiSKYj–@‚Ș‚ ‚éDőF‘̉đÍ‚ÍŽè‹Z“I‚ȏKn‚Ș•K—v‚ĆŽžŠÔ‚à—v‚·‚é‚ȘCŠO’ŒŸž‚Ș‰Â”\‚Ć‚ ‚éD—Z‡ˆâ“`Žq‚ÌŒŸo‚ɂ́CŽć‚ÉReverse Transcription Polymerase Chain ReactioniRT-PCRj–@CFluorescence in situ HybridizationiFISHj–@‚Ș‚ ‚éDRT-PCR –@‚Í“€Œ‹•W–{‚âƒpƒ‰ƒtƒBƒ“•ï–„•W–{‚©‚çŽîᇍŚ–E‚ÌRNA ‚đ’Šo‚”‚œ‚Ì‚ż‚É—Z‡ˆâ“`Žq‚đŒŸo‚·‚é•û–@‚Ć‚ ‚èC”äŠr“IˆÀ‰ż‚É’ZŽžŠÔ‚ĆŒ‹‰Ê‚đ“Ÿ‚é‚±‚Æ‚Ș‚Ć‚«‚éDˆê”Ê“I‚Ƀpƒ‰ƒtƒBƒ“•ï–„•W–{‚Ć‚Í“€Œ‹•W–{‚Æ”ä‚ŚŒŸo—Š‚Ș—Ž‚ż‚é‚Æ‚ł‚ê‚é‚œ‚߁Cˆ««‚đ‹^‚€ê‡‚ɂ͐¶ŒŸŽž‚É“€Œ‹•W–{‚đ•Û‘¶‚”‚Ä‚š‚­‚±‚Æ‚Ș–]‚Ü‚”‚ąDFISH –@‚Í‘gD•W–{ă‚ĆŒuŒő•WŽŻƒvƒ[ƒu‚đ”œ‰ž‚ł‚č—Z‡ˆâ“`Žq‚đŒŸo‚·‚é•û–@‚ƁC—Z‡ˆâ“`Žq‚̃oƒŠƒG[ƒVƒ‡ƒ“‚ɍ¶‰E‚ł‚ê‚É‚­‚ąDŒ‡“_‚Æ‚”‚ẮCRTPCR –@‚̓Rƒ“ƒ^ƒ~ƒl[ƒVƒ‡ƒ“‚É‚æ‚Á‚Ä‹U—z«‚Æ‚È‚éê‡‚Ș‚ ‚邱‚ƁCFISH –@‚Í‚â‚⍂‰ż‚Ć‘œ­ŽžŠÔ‚Ș‚©‚©‚邱‚ƁC”»’è‚ɏKn‚đ—v‚·‚邱‚Æ‚Ș‹“‚°‚ç‚ê‚éD‚Ü‚œ‚ą‚ž‚ê‚Ì•û–@‚É‚š‚ą‚Ä‚àCƒTƒ“ƒvƒ‹‚Ì•Û‘¶ó‘Ô‚âŽè‹Z“I‚ȃ~ƒXC—Z‡ˆâ“`Žq‚̃oƒŠƒG[ƒVƒ‡ƒ“‚É‚æ‚Á‚Ä‹U‰A«‚Æ‚È‚é‰Â”\«‚Ș‚ ‚éDRT-PCR –@‚ÆFISH –@‚ÌŒŸo—͈͂꒷ˆê’Z‚Ć—D—ò‚Í‚ ‚Ü‚è‚È‚ą‚Æ‚ł‚ê‚éiT2F12436CEV level ⅣjD‚±‚ê‚ç‚Ì“Á’„‚đ\•Ș‚É”FŽŻ‚”Cf’f‚ÉŠˆ—p‚·‚é•K—v‚Ș‚ ‚éD

•\1 Žć‚È“î•”ŽîᇂƐf’f“IˆÓ‹`‚Ì‘ć‚«‚ąőF‘Ì“]À‚Æ—Z‡ˆâ“`Žq
Žî@ᇠőF‘Ì“]À —Z‡ˆâ“`Žq

ŠŠ–Œ“śŽî

t(X;18)(p11;q11)

SYT(SS18)-SSX1
SYT(SS18)-SSX2

œŠO«Ewing “śŽî

t(11;22)(q24;q12)
t(11;22)(q22;q12)

EWS-FLI1
EWS-ERG

–E‘ƒŒ^‰Ą–ä‹Ű“śŽî

t(2;13)(q35;q14)
t(1;13)(q36;q14)

PAX3-FKHR
PAX7-FKHR

’W–ŸŚ–E“śŽî

t(12;22)(q13;q12)

EWS-ATF1

”S‰tŒ^Ž‰–b“śŽî

t(12;16)(q13;p11)
t(12;22)(q13;q12)

TLS(FUS)-CHOP
EWS-CHOP

–E‘ƒó“î•”“śŽî

t(X;17)(p11;q25)

ASPL-TFE3

œŠO«”S‰tŒ^““śŽî

t(9;22)(q22;q12)
t(9;17)(q22;q11)

EWS-CHN(TEC)
TAF2N(RBP56)-CHN(TEC)

—Č‹N«”畆üˆÛ“śŽî

t(17;22)(q22;q13)

COL1A1-PDGFB

yƒGƒrƒfƒ“ƒXz
  • ˆâ“`ŽqŒŸž‚É‚æ‚é—Z‡ˆâ“`Žq‚ÌŒŸo—Š‚Í•ń‚É‚æ‚è‚΂ç‚‚«‚Ș‚ ‚é‚ȘCEwing “śŽî/PNET ‚Ć‚ÍEuro-E.W.I.N.G. 99 ‘œŽ{Ę‹€“ŻŒ€‹†‚É‚š‚Ż‚é703 —á‚Ì‘OŒü‚«ŒŸ“ą‚Ć—Z‡ˆâ“`Žq‚Ș633 —ái–ń90%j‚ĆŒŸo‚ł‚ê‚Ä‚ą‚éiT2F12253CEV level ⅤjD–E‘ƒŒ^‰Ą–ä‹Ű“śŽî‚Ć‚ÍChildren's Oncology Group ‚Ì78 —á’†61 —ái–ń78%j‚ĆŒŸo‚ł‚ê ‚Ä‚ą‚éiT2F12432CEV level ⅤjDŠŠ–Œ“śŽî‚Ć‚Í•a—Šw“I‚ɐf’f‚ł‚ê‚œ88 —á‚ɑ΂”‚Ĉâ“`ŽqŒŸž‚đs‚ąC77 —ái–ń90%j‚Ć—z«‚Ć‚ ‚Á‚œiT2F12434CEV level ⅤjD’W–ŸŚ–E“śŽî‚Ć‚ÍFrench sarcoma group ‚Ì38 —á’†32 —ái–ń86“j‚Ć—z«‚Ć‚ ‚Á‚œiT2C00139CEV level ⅤjD‚±‚ê‚ç‚ÌŒ‹‰Ê‚©‚çC—Z‡ˆâ“`Žq‚ȘŒŸo‚ł‚ê‚È‚ą‚±‚Æ‚đœŠOf’f‹K€‚Æ‚”‚Ä—p‚ą‚邱‚Ƃ͐Td‚ɍs‚í‚È‚­‚Ä‚Í‚È‚ç‚È‚ąD
y•¶@ŒŁz
1j T2F12436
Machado I, Noguera R, Pellin A et alFMolecular diagnosis of Ewing sarcoma family of tumorsFa comparative analysis of 560 cases with FISH and RTPCR. Diagn Mol Pathol 2009G18i4jF189-199@mEV Level ‡Wn
2j T2F12253
Le Deley MC, Delattre O, Schaefer KL et alFImpact of EWS-ETS fusion type on disease progression in Ewing's sarcoma/peripheral primitive neuroectodermal tumorFprospective results from the cooperative Euro-E. W.I.N.G. 99 trial. J Clin Oncol 2010G28i12jF1982-1988@mEV Level ‡Xn
3j T2F12432
Barr FG, Smith LM, Lynch JC et alFExamination of gene fusion status in archival samples of alveolar rhabdomyosarcoma entered on the Intergroup Rhabdomyosarcoma Study-III trialFa report from the Children's Oncology Group. J Mol Diagn 2006G8i2jF202-208@mEV Level ‡Xn
4j T2F12434
Guillou L, Coindre J, Gallagher G et alFDetection of the synovial sarcoma translocation tiX;18jiSYT;SSXjin paraffin-embedded tissues using reverse transcriptase-polymerase chain reactionFa reliable and powerful diagnostic tool for pathologists. A molecular analysis of 221 mesenchymal tumors fixed in different fixatives. Hum Pathol 2001G32i1jF105-112@mEV Level ‡Xn
5j T2C00139
Coindre JM, Hostein I, Terrier P et alFDiagnosis of clear cell sarcoma by real-time reverse transcriptase-polymerase chain reaction analysis of paraffin embedded tissuesFclinicopathologic and molecular analysis of 44 patients from the French sarcoma group. Cancer 2006G107i5j 1055-1064@mEV Level ‡Xn

‘æ‚VÍ@“î•”“śŽî‚Ì—\Œă

Clinical QuestionE„§ˆê——‚Ö


CQ 1
—\ŒăˆöŽq‚Í
—v–ń
Grade B
 
 
‚·‚Ś‚Ä‚Ì‘gDŒ^‚É‚š‚ą‚ĉ“Šu“]ˆÚ‚⃊ƒ“ƒpß“]ˆÚ‚Í—\Œă•s—LjöŽq‚Ć‚ ‚éD”ń‰~Œ`Ś–E“śŽî”ń“]ˆÚ—á‚É‚š‚ą‚ẮCŽîᇂ̔­¶•”ˆÊC‘ć‚«‚łC[‚łCˆ««“xC‘gDŒ^C‰fŽž‚Ì”N—îCŰœ‰C‹ÇŠÄ”­‚Í—\ŒăˆöŽq‚Ć‚ ‚éD
y‰đ@àz

‰fŽž‚ɉ“Šu“]ˆÚ‚đ”ș‚€“î•”“śŽî‚Ì2 ”N¶‘¶—Š‚Í–ń20“‚Ć‚ ‚èC”ń“]ˆÚ—á‚Æ”äŠr‚”‚«‚í‚ß‚Ä—\Œă•s—Ç‚Ć‚ ‚émiT2F12443CEV level ⅣjCiT2F12441CEV level ⅣjnD

ƒŠƒ“ƒpß“]ˆÚ‚́C]—ˆˆêŠ‡‚”‚ĉ“Šu“]ˆÚ‚Æ“Ż“™‚Ì—\Œă•s—LjöŽq‚Æ‚”‚Ĉ”‚í‚ê‚Ä‚«‚œ‚ȘiT2F12442CEV level ⅤjC‹ß”NCŒÇ—§«‚̃Šƒ“ƒpß“]ˆÚ‚͐ۏœ‚·‚邱‚Æ‚É‚æ‚è—\Œă‚Ș‚â‚â‰ü‘P‚ł‚ê‚é‰Â”\«‚Șo‚Ä‚«‚œmiT2F12441CEV level ⅣjCiT2F03504CEV level ⅣjCiT2F12408CEV level ⅤjCiT2F00648CEV level ⅣjnD

Žîᇂ̔­¶•”ˆÊ‚ÍăŽˆC‰șŽˆC‹č•Ç/ ‘ÌŠČCŒă• –Œ/ • o“àC“à‘ŸŠíC“ȘŒz•”‚ɂ‚ą‚ÄŠeX‚Ì—\Œă‚ȘŒŸ“ą‚ł‚ê‚Ä‚ą‚éDŽlŽˆ‚ɔ䂌‚ÄŽlŽˆˆÈŠO‚Ì”­¶Ç—á‚Ì—\Œă‚Í•s—Ç‚Ć‚ ‚éiT2F08283CEV level ⅣjD

Žîá‡‚Ì‘ć‚«‚ł‚Í‘œ‚­‚̉đÍ‚Ć—\ŒăˆöŽq‚Æ‚ł‚ê‚Ä‚ą‚éD5 cm ‚đ’Ž‚Š‚é‚à‚Ì‚Í—\Œă•s—Ç‚Ć‚ ‚éirelative riskFRR 1.96 `3.12jmiTF00842CEV level ⅣjCiT2F08182CEV level ⅣjCiT2F12438CEV level ⅣjnD‚ ‚é‚ą‚́C5 cm –ą–ž‚ÌŽîᇂɔ䂦C10 cm ‚đ’Ž‚Š‚éŽîᇂ͗\Œă•s—Ç‚Ć‚ ‚éiRR 2.0 `3.40jmiT2F01223CEV level ⅣjCiTF01248CEV level ⅣjnD

ó‘w‹Ű–Œ‚æ‚è[•”‚É‘¶Ę‚·‚éŽîᇂ́Có‘w‹Ű–Œ‚æ‚èó‚ąŽîᇂæ‚èC—\Œă•s—Ç‚Ć‚ ‚éiRR 1.3 `6.35jmiTF00842CEV level Ⅳ jCiT2F08182CEV level Ⅳ jCiT2F12438CEV level ⅣjCiT2F01223CEV level ⅣjnD

ˆ««“x‚à‹­—Í‚È—\ŒăˆöŽq‚Ć‚ ‚éD‚ˆ««“xŽîᇂ͒ራ«“xŽîᇂɔ䂦—\Œă•s—Ç‚Ć‚ ‚éiRR 2.1 `4.76jmiT2F08182CEV level Ⅳ jCiT2F01223CEV level Ⅳ jCiTF01248CEV level ⅣjnD‹ß”NCˆ««“x‚ÍGrade 1 ‚©‚ç3 ‚Ì3 ’iŠK‚É•Ș—Ț‚ł‚ê‚邱‚Æ‚à‘œ‚­CGrade ‚Ș‚ ‚Ș‚é‚ɂ‚ê‚Ä—\Œă•s—Ç‚Ć‚ ‚éiGrade 2FRR 3.12CGrade 3FRR 7.81jiT2F12439CEV level ⅣjD•Ș—ȚƒVƒXƒeƒ€‚Æ‚”‚ẮCNCI ‚ÆFNCLCC ‚Ì2 ‚‚ȘL‚­Žg—p‚ł‚ê‚Ä‚ą‚é‚ȘCŒăŽÒ‚Ì•û‚Ș—\Œă‚đ‚æ‚­”œ‰f‚”‚Ä‚š‚èC‚©‚ÂŒŸŰ‚à‚ł‚ê‚Ä‚ą‚邱‚Æ‚©‚çC‚æ‚蕁‹y‚”‚‚‚ ‚éDFNCLCC ‚Ƃ́CŽîᇂ̕Ș‰»“xi•\1jC‰óŽ€‚Ì’ö“xCŠj•Ș—ô”‚ÉŠeXƒXƒRƒA‚Ș‚‚«C‚±‚ê‚ç‚̃XƒRƒA‚̍‡Œv“_”‚æ‚èGrade ‚đ‹‚ß‚éŽd‘g‚Ę‚Æ‚È‚Á‚Ä‚ą‚éi•\2jmiT2F12440CEV level ⅣjCiT2F08185CEV level ⅣjnD

•\1 ‘gDŒ^‚É‚æ‚éƒXƒRƒA
Histologic Type Tumor
Differentiation
Score
Well-differentiated liposarcoma

1

Myxoid liposarcoma

2

Round cell liposarcoma

3

Dedifferentiated liposarcoma

3

Pleomorphic liposarcoma

3

Well-differentiated fibrosarcoma

1

Conventional fibrosarcoma

2

Poorly differentiatied fibrosarcoma

3

Well-differentiated MPNST

1

Conventional MPNST

2

Poorly differentiated MPNST

3

Epithelioid MPNST

3

Malignant Triton tumor

3

Well-differentiated malignant hemangiopericyatoma

1

Conventional hemangiopericytoma

2

Myxoid MFH

2

Typical storiform-pleomorphic MFH

2

Giant-cell and inflammatory MFH

3

Well-differentiated leiomyosarcoma

1

Conventional leiomyosarcoma

2

Poorly differentiated/pleomorphic/epithelioid leiomyosarcoma

3

Extraskeletal myxoid chondrosarcoma

2

Synovial sarcoma

3

Rhabdomyosarcoma

3

Well-differentiated chondrosarcoma

1

Myxoid chondrosarcoma

2

Mesenchymal chondrosarcoma

3

Conventional angiosarcoma

2

Poorly differentiated/epithelioid angiosarcoma

3

Extraskeletal osteosarcoma

3

Ewing sarcoma/PNET

3

Alveolar soft part sarcoma

3

Epithelioid sarcoma

3

Malignant rhabloid tumor

3

Clear cell sarcoma

3

Undifferentiated sarcoma

3

•\2 •Ș‰»“xCŽîᇉ󎀁CŠj•Ș—ô”‚É‚æ‚éƒXƒRƒA‚Æ‚»‚ê‚ç‚ÉŠî‚Ă‚ą‚œGrade
Parameter criteria

I. Tumor
differentiation
i•\1 ŽQÆj

1

Sarcomas closely resembling normal adult mesenchymal tissue.

2

Sarcomas for which the histological typing is certain.

3

Embryonal sarcomas, undifferentiated sarcomas, and sarcomas of doubtful tumor type.

Ⅱ. Tumor necrosis

0

No necrosis on any examined slides.

1

Less than 50% tumor necrosis for all the examined tumor surface.

2

Tumor necrosis on more than half of the examined tumor surface.

Ⅲ. Mitosis Count

1

0 to 9 mitoses per 10 HPF

2

10 to 19 mitoses per 10 HPF

3

More than 20 mitoses per 10 HPF
Histologic Grade

1

Sum of scores for I, Ⅱ, ⅢF2-3

2

Sum of scores for I, Ⅱ, ⅢF4-5

3

Sum of scores for I, Ⅱ, ⅢF6-8

‘gDŒ^‚à—\ŒăˆöŽq‚Æ‚”‚Ä‚ ‚°‚ç‚ê‚邱‚Æ‚Ș‘œ‚ą‚ȘC•¶ŒŁ‚É‚æ‚è•K‚ž‚”‚àˆê’v‚”‚Ä‚ą‚È‚ąDüˆÛ“śŽî‚Ș—\Œă—ǍD‚Æ‚ł‚ê‚Ä‚ą‚邱‚Æ‚Ș‘œ‚ąmiT2F08182CEV level ⅣjCiT2F01223CEV level ⅣjCiTF01248CEV level ⅣjnD

‰fŽž‚Ì”N—î‚à—\ŒăˆöŽq‚Æ‚”‚Ä•ń‚ł‚ê‚Ä‚š‚èC‚—îŽÒ‚Ù‚Ç—\Œă•s—Ç‚Ć‚ ‚éiRR 1.03 `1.25jmiT2F01223CEV level ⅣjCiTF01248CEV level ⅣjnD

•Ą”‚Ì—\ŒăˆöŽq‚©‚çŒÂX‚ÌŠłŽÒ‚Ì—\Œă‚𐄑Ș‚·‚é‚͍̂ą“ï‚Ć‚ ‚é‚œ‚߁C‚±‚ê‚ç‚Ì—\ŒăˆöŽq‚đ‚à‚Æ‚É‹ï‘Ì“I‚È—\Œă‚đ—\‘Ș‚·‚éƒmƒ‚ƒOƒ‰ƒ€‚ȘìŹ‚ł‚ê•ń‚ł‚ê‚Ä‚ą‚éiT2F08283CEV level ⅣjD‚Ü‚œCMemorial Sloan-Kettering Cancer Center ‚̃z[ƒ€ƒy[ƒW‚ĆŒvŽZƒc[ƒ‹‚Ș’ń‹Ÿ‚ł‚ê‚Ä‚ą‚éD

Űœ‰‚ƋǏŠÄ”­‚́CŽĄ—Ă‚ÌŒ‹‰Ê‚Ć‚ ‚é‚Ì‚Ć^‚̈ӖĄ‚Ć‚Ì—\ŒăˆöŽq‚Æ‚Í‚ą‚Š‚È‚ą‚ȘC—\ŒăˆöŽq‚Æ‚”‚ÄŽæ‚èă‚°‚ç‚ê‚éê‡‚Ș‚ ‚éD’f’[—z«‚Í—\Œă•s—Ç‚Ć‚ ‚éiRR 1.25 `3.62jmiTF00842CEV level Ⅳ jCiT2F08182CEV level Ⅳ jCiT2F01223CEV level ⅣjnD‹ÇŠÄ”­‚à—\Œă•s—Ç‚Æ‚·‚镶ŒŁ‚Ș‚ ‚éiRR 1.25 `1.5jmiT2F08182CEV level ⅣjCiT2F01223CEV level ⅣjnD‹ÇŠÄ”­‚đ‚«‚œ‚”‚œŽž“_‚Ć‚Ì—\Œă•]‰ż‚É‚àCƒmƒ‚ƒOƒ‰ƒ€‚ȘìŹ‚ł‚ê‚Ä‚ą‚éiT2F12444CEV level ⅣjD

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1,066 —á‚ÌŽlŽˆ”­¶“î•”“śŽîÇ—á’†C39 —á3.7“‚ɃŠƒ“ƒpß“]ˆÚ‚Ș”­¶‚”‚Ä‚ą‚œD—Ță”ç“śŽîC‰Ą–ä‹Ű“śŽîC’W–ŸŚ–E“śŽîCŒŒŠÇ“śŽî‚̓Šƒ“ƒpß“]ˆÚ”­¶—Š‚ȘŠeX20“C19“C11.1“C11.1“‚Æ•p“x‚Ș‚‚©‚Á‚œDƒŠƒ“ƒpß“]ˆÚ‚ÌŰœ‚đŽó‚Ż‚œ30 —á‚Ì5 ”N¶‘¶—Š‚Í57“‚Ć‚ ‚Á‚œ‚̂ɑ΂”CŰœ‚đŽó‚Ż‚È‚©‚Á‚œ9 —á‚Í30 ƒ•ŒŽˆÈ“à‚É‘S—ᎀ–S‚”‚œDŒÇ—§«ƒŠƒ“ƒpß“]ˆÚÇ—á‚Ì4 ”N¶‘¶—Š‚Ș71“‚Ć‚ ‚Á‚œ‚̂ɑ΂”C‘Sg‚Ö‚Ì”dŽí‚Ć‚ ‚Á‚œÇ—á‚Ć‚Í21“‚Ć‚ ‚Á‚œDŒÇ—§«ƒŠƒ“ƒpß“]ˆÚ‚ÆAJCC/UICCi‘æ6 ”ƁjStage Ⅲ‚̏Ǘá‚Ì—\Œă‚Éˆá‚ą‚Í‚Ę‚ç‚ê‚È‚©‚Á‚œiT2F12444CEV level ⅣjD

y•¶@ŒŁz
1j T2F12443
Kane JM, Finley JW, Driscoll D et alFThe treatment and outcome of patients with soft tissue sarcomas and synchronous metastases. Sarcoma 2002G6i2jF69-73@mEV Level Ⅳn
2j T2F12441
Ferguson PC, Deheshi BM, Chung P et alFSoft tissue sarcoma presenting with metastatic diseaseFOutcome with primary surgical resection. Cancer 2010G117i2jF372-379@mEV Level Ⅳn
3j T2F12442
Gaakeer HA, Albus-Lutter CE, Gortzak E et alFRegional lymph node metastases in patients with soft tissue sarcomas of the extremities, what are the therapeutic consequences? Eur J Surg Oncol 1988G14i2jF151-156@mEV level Ⅴn
4j T2F03504
Fong Y, Coit DG, Woodruff JM et alFLymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993G217i1jF72-77@mEV Level Ⅳn
5j T2F12408
Mazeron JJ, Suit HDFLymph nodes as sites of metastases from sarcomas of soft tissue. Cancer 1987G60i8jF1800-1808@mEV level Ⅴn
6j T2F00648
Riad S, Griffin AM, Liberman B et alFLymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 2004G426F129-134@mEV Level Ⅳn
7j T2F08283
Kattan MW, Leung DH, Brennan MFFPostoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002G20i3jF791-796@mEV Level Ⅳn
8j TF00842
Ueda T, Yoshikawa H, Mori S et alFInfluence of local recurrence on the prognosis of soft-tissue sarcomas. J Bone Joint Surg Br 1997G79i4jF553-557@mEV Level Ⅳn
9j T2F08182
Pisters PW, Leung DH, Woodruff J et alFAnalysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996G14i5jF1679-1689@mEV Level Ⅳn
10j T2F12438
Coindre JM, Terrier P, Bui NB et alFPrognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996G14i3jF869-877@mEV Level Ⅳn
11j T2F01223
Weitz J, Antonescu CR, Brennan MFFLocalized extremity soft tissue sarcomaFimproved knowledge with unchanged survival over time. J Clin Oncol 2003G21i14jF2719-2725@mEV Level Ⅳn
12j TF01248
Singer S, Corson JM, Gonin R et alFPrognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994G219i2jF165-173@mEV Level Ⅳn
13j T2F12439
Coindre JM, Terrier P, Guillou L et alFPredictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomasFa study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer 2001G91i10jF1914-1926@mEV Level Ⅳn
14j T2F12440
Coindre JM, Trojani M, Contesso G et alFReproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer 1986G58i2jF306-309mEV Level Ⅳn
15j T2F08185
Guillou L, Coindre JM, Bonichon F et alFComparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 1997G15i1jF350-362@mEV Level Ⅳn
16j T2F12444
Kattan MW, Heller G, Brennan MFFA competing-risks nomogram for sarcoma-specific death following local recurrence. Stat Med 2003G22i22jF 3515-3525@mEV Level Ⅳn

CQ 2
‹ÇŠÄ”­‚ÌŠëŒŻˆöŽq‚Í
—v–ń
Grade A
Žîá‡‚Ì‘ć‚«‚ł‚ÆŰœ‰‚́C”ń‰~Œ`Ś–E“śŽî”ń“]ˆÚ—á‚É‚š‚ą‚ċǏŠÄ”­‚ÌŠëŒŻˆöŽq‚Ć‚ ‚éD
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5 cm ‚ ‚é‚ą‚Í10 cm ‚đ’Ž‚Š‚é‘ć‚«‚ł‚ÌŽîᇂ͋ǏŠÄ”­‚ÌŠëŒŻˆöŽq‚Ć‚ ‚é‚Æ‚·‚镶ŒŁ‚Ș‚ ‚éiT2F01223CEV level ⅣjD‚Ü‚œC•s“KŰ‚ÈŰœ‰‚Í‘gDŠw“I‚É’f’[—z«‚ƂȂ邱‚Æ‚Ș‘œ‚­C‚»‚̏ꍇ‚͋ǏŠÄ”­‚ÌŠëŒŻˆöŽq‚Æ‚È‚éirelative riskFRR 1.25 `3jmiT2F01223CEV level ⅣjCiT2F12438CEV level ⅣjCiTF01239CEV level ⅣjCiT2F08182CEV level ⅣjCiTF01248CEV level ⅣjnD

y•¶@ŒŁz
1j T2F01223
Weitz J, Antonescu CR, Brennan MFFLocalized extremity soft tissue sarcomaFimproved knowledge with unchanged survival over time. J Clin Oncol 2003G21i14jF2719-2725@mEV Level Ⅳn
2j T2F12438
Coindre JM, Terrier P, Bui NB et alFPrognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol 1996G14i3jF869-877@mEV Level Ⅳn
3j TF01239
Gustafson PFSoft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 1994G259F1-31@mEV Level Ⅳn
4j T2F08182
Pisters PW, Leung DH, Woodruff J et alFAnalysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996G14i5jF1679-1689@mEV Level Ⅳn
5j TF01248
Singer S, Corson JM, Gonin R et alFPrognostic factors predictive of survival and local recurrence for extremity soft tissue sarcoma. Ann Surg 1994G219i2jF165-173@mEV Level Ⅳn

‘æ‚WÍ@“î•”“śŽî‚ÌŽèp

Clinical QuestionE„§ˆê——‚Ö


CQ 1
Žèp‚Ì•K—v«‚Í
—v–ń
Grade A
 
Žèp‚Í“î•”“śŽîŽĄ—Ă‚Ì—v‚Ć‚ ‚èCŒŽ‘„‚Æ‚”‚ÄŽèp‚É‚æ‚éŰœ‚Șs‚í‚ê‚éDŽèp’P“Æ‚Ć“KŰ‚ÈŰœ‰‚ÌŠm•Û‚Șą“ï‚ȏꍇ‚ɂ́C‰»Šw—Ă–@‚â•úŽËüŽĄ—Ă‚đ•č—p‚·‚éD
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“î•”“śŽî‚ÌŽĄ—Ă‚ÍŽèp‚É‚æ‚éŰœ‚ȘŒŽ‘„‚Ć‚ ‚éDŒ»ĘCŠłŽˆ‰·‘¶‚ȘŽèp‚ÌŽć—Ź‚Æ‚È‚èŠłŽˆŰ’f‚Í10“‚É‚Ü‚Ć’á‰ș‚”‚œiT2R00002jD‚±‚̏ꍇ‚àÄ”­‚đ—\–h‚·‚é‚œ‚߂ɂ́C“KŰ‚ÈŰœ‰‚đŠm•Û‚”‚œă‚Ć‚ÌŰœ‚ȘŒŽ‘„‚Ć‚ ‚éD

ŹŽ™‚̉Ą–ä‹Ű“śŽîCEwing “śŽî‚͉»Šw—Ă–@‚Ì‘tŒű—Š‚Ș‚‚ą‚œ‚߁Cp‘O‰»Šw—Ă–@‚É‚æ‚èŰœ”͈͂̏kŹ‚Ș‰Â”\‚É‚È‚éê‡‚Ș‚ ‚éiT2R00002jD•úŽËü’P“ÆŽĄ—Ă‚ÍŽîᇂȘŰœ•s‰Â”\‚ȏꍇ‚⊳ŽÒ‚̏ó‘ԁi‚—îC‡•čÇ‚Ȃǁj‚É‚æ‚èŽèp‚Șs‚Š‚È‚ąê‡‚È‚Ç‚É—p‚ą‚ç‚ê‚éiT2F09545CEV level ⅤjD

y•¶@ŒŁz
1j T2R00002
Weiss SW, Goldblum JRFChapter 2 Clinical evaluation and treatment of soft tissue tumors. Enzinger and Weissfs Soft Tissue Tumors, 5th ed, Mosby-Elsevier, St LouisG2008.
2j T2F09545
Kepka L, Suit HD, Goldberg SI et alFResults of radiation therapy performed after unplanned surgeryiwithout re-excisionjfor soft tissue sarcomas. J Surg Oncol 2005G92i1jF39-45@mEV level Ⅴn

CQ 2
“KŰ‚ÈŰœ‰‚Æ‚Í
—v–ń
Grade B
Žîᇔœ‰ž‘w‚ÌŠO‚Ɛۏœ‚·‚éL”͐ۏœ‰‚Ć‚ ‚éD
y‰đ@àz

Žîᇔœ‰ž‘w‚Ƃ́CŽîᇂ̖Œ—l‘gD‚Æ‚»‚ÌŽüˆÍ‚̏oŒŒ‘ƒC•ÏF‚”‚œ‹Ű“śC•‚Žîó‚Ì‘gD‚È‚Ç“śŠá“I‚ȕϐF•”‚đŽw‚”CŰœ‰•]‰ż‚ɍۂ”‚ẮCŽîᇂƌ©‚È‚·D”œ‰ž‘w‚đŰœü‚Ș’ʉ߂·‚ê‚ΕӉŰœ‰‚Ć‚ ‚éDL”͐ۏœ‰‚Ƃ́C”œ‰ž‘w‚ȘŒ’í‚È‘gD‚Ć•ï‚Ü‚ê‚é‚æ‚€‚É‚”‚Đۏœ‚ł‚ê‚Ä‚ą‚éó‘Ô‚Ć‚ ‚éiT2R00007jDL”͐ۏœ‰‚Ƃ́CŒ’í‚È‘gD‚ÌŒú‚łiŽîá‡‚ÆŰœü‚Æ‚Ì‹——Łj‚É‚æ‚Á‚čȘŽĄ«‚ɍ·‚Ș‚Ć‚éDŽîᇂ©‚ç‚Ì‹——Ł‚Ș—Ł‚ê‚é‚قǍȘŽĄ«‚Í‚ ‚Ș‚é‚ȘCpŒă‹@”\‚ÍŽž‚í‚ê‚éDŽîᇎüˆÍ‚ɂ́C‹Ű–ŒCŠÖß•ïCäFâCŒŒŠÇŠO–ŒC_Œoă–Œ‚È‚ÇŽîᇐZ‚ɑ΂”‚Ä’ïR«‚đŽŠ‚·‘gDibarrierj‚Ș‘¶Ę‚·‚éD‚±‚Ìbarrier ‚́CŽîᇂ©‚çŰœü‚Ü‚Ć‚Ì‹——Ł‚ÉŠ·ŽZ‚·‚邱‚Æ‚Ș‰Â”\‚Ć‚ ‚èCbarrier ‚đ—˜—p‚·‚邱‚Æ‚É‚æ‚èCŰœ‚͈̔͂đkŹ‚Ć‚«‚éD‚ˆ««“śŽî‚Ć‚ÌÄ”­—Š‚́CŽîᇂ©‚ç2 cm ‘Š“–‚ÌŒ’í‘gD‚đ‚‚Ż‚Đۏœ‚”‚œê‡‚É‚Í7`13“‚Ć‚ ‚èC’ራ«“śŽî‚Ƃ́C1 cm ‘Š“–‚ÌŒ’í‘gD‚đ‚‚Ż‚Đۏœ‚”‚œê‡10“‚Ć‚ ‚Á‚œmiT2F05495CEV level ⅤjCiT2F12445jnD‚±‚ê‚͋ǏŠZŒXŒü‚đŽŠ‚·“śŽî‚àŠÜ‚ń‚ŸÄ”­—Š‚Ć‚ ‚éD‚»‚±‚ƁC‹ÇŠÄ”­—Š10% ˆÈ‰ș‚đ“KŰ‚ÈŰœ‰‚Æ‚·‚é‚ƁCZŒXŒü‚É–R‚”‚ą‚ˆ««“śŽî‚Ć‚Í2 cm ‘Š“–ˆÈă‚ÌŒ’í‘gD‚đ‚‚Ż‚Ä‚ÌŰœC’ራ«“śŽî‚Ć‚Í1 cm ‘Š“–ˆÈă‚ÌŒ’í‘gD‚đ‚‚Ż‚Ä‚ÌŰœ‚Ș“KŰ‚ÈŰœ‰‚Æ‚È‚éDZŒXŒü‚đŽŠ‚·‚±‚Æ‚Ș‘œ‚ąˆ««üˆÛ«‘gD‹…Žî‚É‚š‚Ż‚éÄ”­—Š‚́C1 cm ‘Š“–‚ÌŒ’í‘gD‚đ‚‚Ż‚Ä‚ÌŰœ‚Ć‚Í29% ‚Ć‚ ‚é‚ȘCŰœ”͈͂đL‚°‚邱‚Æ‚É‚æ‚èÄ”­—Š‚đ‰ș‚°‚邱‚Æ‚Ș‰Â”\‚Ć‚ ‚Á‚œmiT2F05495CEV level ⅤjCiT2F12445jnD‚Ü‚Æ‚ß‚é‚ƁCĆ‚àL‚ąŰœ”͈͂đ•K—v‚Æ‚·‚é‚Ì‚ȘCZŒXŒü‚Ș‹­‚ą“śŽî‚Ć‚ ‚éDŽŸ‚ą‚Ć”ńZ«‚̍‚ˆ««“śŽî‚Ć‚ ‚èC”ńZ«‚̒ራ«“śŽî‚ȘĆ‚à‹·‚ąL”͐ۏœ‰‚Æ‚È‚éD•úŽËüŽĄ—Ă‚đ•č—p‚č‚ž‚É2.5 cm ‚ÌŰœ‰‚Ć5 ”NŠÔ‚̍Ĕ­—Š‚́Cˆ««“x‚ÉŠÖŒW‚È‚­10.8“‚Æ‚Ì•ń‚Ș‚ ‚éiT2F04474CEV level ⅤjD

Žèp’P“Æ‚Ć“KŰ‚ÈŰœ‰‚ÌŠm•Û‚Ș‚Ț‚ž‚©‚”‚ą‚Æ‚«‚É•úŽËüŽĄ—Ă‚Ș•č—p‚ł‚ê‚éD

y•¶@ŒŁz
1j T2R00007
“ú–{źŒ`ŠO‰ÈŠw‰ïœE“î•”Žîᇈψő‰ïi•ÒjFœE“î•”“śŽîŰœ‰•]‰ż–@. ‹àŒŽo”ƁC“Œ‹žG1989
2j T2F05495
Kawaguchi N, Ahmed AR, Matsumoto S et alFThe concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res 2004G419F165-172@mEV level Ⅴn
3j T2F12445
Manabe J. Kawaguchi, N et alFAnalysis of safety margins based on registration of surgical margins in Japan 1980-2005. Mod Surg Challenges Musculoskel Sarcoma 2007G16F177-183
4j T2F04474
Sampo M, Tarkkanen M, Huuhtanen R et alFImpact of the smallest surgical margin on local control in soft tissue sarcoma. Br J Surg 2008G95i2jF237-243@mEV level Ⅴn

CQ 3
’ljÁL”͐ۏœ‚̈Ӌ`‚Í
—v–ń
Grade B
 
Œv‰æ“I‚ɍs‚í‚ê‚È‚©‚Á‚œŽèpŒă‚ÍŽîᇂ̎c‘¶‚É‚æ‚éÄ”­‚̉”\«‚Ș‚ ‚é‚œ‚߁CŒŽ‘„‚Æ‚”‚ĒljÁL”͐ۏœ‚Ș•K—v‚Ć‚ ‚éD
y‰đ@àz

Œv‰æ“I‚ɍs‚í‚ê‚È‚©‚Á‚œŽèpŒăC‚š‚æ‚ŃŒv‰æ‚ł‚ê‚œŽèp‚Ć‚ ‚Á‚Ä‚àŰœ‰‚ȘŽîᇂƉ˜ő‚ł‚ê‚Ä‚ą‚œê‡C‚»‚±‚©‚çÄ”­‚â“]ˆÚ‚Ș‹N‚±‚è‚Š‚é‚œ‚ߒljÁL”͐ۏœ‚ȘŒŽ‘„‚Ć‚ ‚éiT2F12427CEV level ⅤjDŽîᇂȘŽc‘¶‚”‚œê‡‚̍Ĕ­—Š‚Í75“‚Æ‚Ì•ń‚Ș‚ ‚éiT2F00995CEV level ⅤjDŽîᇂȘŽc‘¶‚”‚œ‚Ü‚ÜŒo‰ßŠÏŽ@‚·‚邱‚Æ‚Í—Ï—“I–â‘è‚Ș‚ ‚é‚œ‚߁C’ljÁL”͐ۏœ‚Ì—L—p«‚ɂ‚ą‚Ä–łìˆŚ‚ÉŒŸ“ą‚”‚œ•ń‚Í‚È‚ąD

Žć—v‚ÈŒŒŠÇ_Œo‘©‚â‘ŸŠí‚Ș‹]”‚É‚È‚ç‚È‚ąê‡‚́C’ljÁL”͐ۏœ‚Ș‘æˆê‘I‘đ‚Ć‚ ‚éD’ljÁL”͐ۏœŒăCŰœȚ—ż‚đŒŸ“ą‚”—\‘zˆÈă‚ÉŽèpፍ­‚ȘL‚ąê‡‚ɂ́C‚ł‚ç‚É•K—v‚ÈŽĄ—Ă‚đ’ljÁ‚·‚邱‚Æ‚Ș‚Ć‚«‚éD’ljÁL”͐ۏœ‚đs‚Á‚œÇ—á‚Ć‚ÌÄ”­—Š‚͏‰‰ń‚©‚çL”͐ۏœ‚đs‚Á‚œ‚à‚Ì‚Æ•Ï‚í‚ç‚žmiT2J00001CEV level ⅤjCiT2F12447CEV level ⅤjCiT2F12446CEV level ⅤjnCÄ”­Œă‚̍L”͐ۏœŒQ‚æ‚è’á‚ąiT2J00002CEV level ⅣjD

’ljÁL”͐ۏœ‚Ș•s‰Â”\‚ȏꍇ‚âC‹@”\‚đ‘ć‚«‚­‘č‚È‚€ƒŠƒXƒN‚Ș‚‚ąê‡‚ɂ́C•úŽËüÆŽË‚đŒŸ“ą‚·‚éD

y•¶@ŒŁz
1j T2F12427
Chandrasekar CR, Wafa H, Grimer RJ et alFThe effect of an unplanned excision of a soft-tissue sarcoma on prognosis. J Bone Joint Surg Br 2008G90i2jF203-208@mEV level Ⅴn
2j T2F00995
Matsumoto S, Ahmed AR, Kawaguchi N et alFResults of surgery for malignant fibrous histiocytomas of soft tissue. Int J Clin Oncol 2003G8i2jF 104-109@mEV level Ⅴn
3j T2J00001
Œ–{œˆê, ìŒû’q‹`, ^“ç@~‚Ù‚©F“î•”“śŽî‚É‚š‚Ż‚é’ljÁL”͐ۏœ—á‚ÌŒŸ“ą. —ՐźŠO 1991G26i6jF701-706@mEV level Ⅴn
4j T2F12447
Fiore M, Casali PG, Miceli R et alFPrognostic effect of re-excision in adult soft tissue sarcoma of the extremity. Ann Surg Oncol 2006G13i1jF110-117mEV level Ⅴn
5j T2F12446
Arai E, Nishida Y, Tsukushi S et alFClinical and treatment outcomes of planned and unplanned excisions of soft tissue sarcomas. Clin Orthop Relat Res 2010G468i11jF3028-3034@mEV level Ⅴn
6j T2J00002
’†@‹I•¶, r–ېMl, –Œˆä@—z‚Ù‚©Fˆ««“î•”Žîᇂɑ΂·‚é’ljÁL”͐ۏœp‚ÌŒŸ“ą. œEŠÖßEèŐ‘Ń 1999G12i4jF435-442@mEV Level Ⅳn

CQ 4
‹ÇŠÄ”­—á‚ÌŽèpŽĄ—Ă‚Í
—v–ń
Grade B
 
Ä”­Ç—á‚Ć‚Í‰‰ńŽèp—á‚æ‚èpŒăÄ”­—Š‚Ș‚‚ą‚œ‚߁CŰ’f‚àŠÜ‚ß‚œȘŽĄ“I‚ÈŽèpŽĄ—Ă‚đl—¶‚·‚Ś‚«‚Ć‚ ‚éD
y‰đ@àz

ˆ««üˆÛ«‘gD‹…Žî‚ɂ‚ą‚Ä‚Ę‚é‚ƁCpŒăÄ”­—Š‚́C‰‰ńŽèp—á‚Ć19.1“CÄ”­Žèp—á‚Ć‚Í53.6“‚Ć‚ ‚èCÄ”­—á‚̏pŒăÄ”­—Š‚Ș‚‚©‚Á‚œDŽîᇔœ‰ž‘w‚æ‚è1`4 cm ‘Š“–‚ÌŒ’í‘gD‚đ‚‚Ż‚Đۏœ‚”‚œê‡‚̍L”͐ۏœ‰‚Ć‚ÌÄ”­—Š‚́C‰‰ńŽèp—á‚Ć‚Í12.1%CÄ”­—á‚Ć‚Í60% ‚Ć‚ ‚Á‚œiT2F00995CEV level ⅤjDŽĄ–ü“IŰœ‰iT2R00007j‚Ć‚ÍÄ”­‚Í‚Ę‚ç‚ê‚È‚©‚Á‚œ‚±‚Æ‚æ‚èCÄ”­•a•Ï‚ɑ΂”‚Ä‚ÍŽĄ–ü“IŰœ‰‚ȘˆÀ‘S‚ƍl‚Š‚ç‚ê‚éD

‘O‰ń‚ÌŽèpፍ­‚͉”\‚Ć‚ ‚ê‚ΐۏœ‚”‚œ•û‚Ș‚æ‚ą‚ȘCፍ­‚đL”ÍˆÍ‚ĆŰœ‚·‚é‚ÆŠłŽˆ‰·‘¶‚Ș‚Ț‚ž‚©‚”‚ąê‡‚ɂ́C•úŽËüŽĄ—Ă‚đ•č—p‚”Űœ‰‚đkŹ‚·‚邱‚Æ‚àl—¶‚·‚éiT2J00003CEV level ⅣjD•úŽËüŽĄ—Ă‚đ•č—p‚”‚œê‡‚̍Ĕ­—Š‚Í’á‰ș‚”‚œiT2J00003CEV level ⅣjD

Űœ‰•]‰ż–@‚É‚š‚ą‚āCŽĄ–ü“IŰœ‰‚Ƃ́CŽîᇔœ‰ž‘w‚ÌŠO‚É5 cm ˆÈă‚ÌŒ’í‘gD‚Ș‘¶Ę‚·‚é‚©CŽîᇔœ‰ž‘w‚ÌŠO‚ÉŒ’í‘gD‚đ‰î‚”‚Äbarrier ‚Ș‘¶Ę‚·‚éê‡‚Ć‚ ‚éD

y•¶@ŒŁz
1j T2R00007
“ú–{źŒ`ŠO‰ÈŠw‰ïœE“î•”Žîᇈψő‰ïi•ÒjFœE“î•”“śŽîŰœ‰•]‰ż–@C‹àŒŽo”ƁC“Œ‹žG1989
2j T2F00995
Matsumoto S, Ahmed AR, Kawaguchi N et alFResults of surgery for malignant fibrous histiocytomas of soft tissue. Int J Clin Oncol 2003G8i2jF 104-109@mEV level Ⅴn
3j T2J00003
Ź–öL‚, Œ–{œˆê, ^“ç@~‚Ù‚©F§ˆł‚Ö‚ÌŽĄ—Ðí—Ș@Ä”­«œE“î•”ˆ««ŽîᇠÄ”­«“î•”“śŽîŽèp‚É‚š‚Ż‚éˆÀ‘S‚ÈŰœ‰. “úź‰ïŽ 2009G83i1jF 22-27@mEV Level Ⅳn

‘æ‚XÍ@“î•”“śŽî‚̉»Šw—Ă–@

Clinical QuestionE„§ˆê——‚Ö


CQ 1
—LŒű‚ȉ»Šw—Ă–@‚Æ‚»‚̈Ӌ`‚Í
—v–ń
Grade A
Grade B
 
 
 
 
 
‰~Œ`Ś–E“śŽî
‚ˆ««“x”ń‰~Œ`Ś–E“śŽîiŽlŽˆ”­¶—áj

‰Ą–ä‹Ű“śŽî‚⍜ŠO«Ewing “śŽî“™‚̉~Œ`Ś–E“śŽî‚É‚š‚ą‚ẮC‰»Šw—Ă–@‚Ș•K{‚ÌŽĄ—Ă‚Ć‚ ‚éDˆ««“î•”Žîá‡‚Ì‘ć‘œ”‚đè‚ß‚é”ń‰~Œ`Ś–E“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚Ì—LŒű«‚ÍŠm—§‚”‚Ä‚ą‚È‚ą‚ȘCŰœ‰Â”\‚Èstage ⅢiAJCC 6th ed.j”ń‰~Œ`Ś–E“śŽî‚ÌŽlŽˆ”­¶—á‚ɑ΂”‚Ä‚Ídoxorubicin ‚š‚æ‚Ńifosfamide ‚𒆐S‚Æ‚”‚œ•â•‰»Šw—Ă–@‚ÌŽÀŽ{‚đl—¶‚·‚Ś‚«‚Ć‚ ‚éD
y‰đ@àz

“î•”“śŽî‚́C‰»Šw—Ă–@‚ɑ΂·‚銎Žó«‚©‚çC‰~Œ`Ś–E“śŽî‚Æ”ń‰~Œ`Ś–E“śŽî‚É•Ș‚Ż‚čl‚Š‚邱‚Æ‚Ș‚Ć‚«‚éD‰~Œ`Ś–E“śŽî‚́C‰Ą–ä‹Ű“śŽî‚⍜ŠO«Ewing “śŽî“™‚Ì‘gDŠw“I‚ɏŹ‰~Œ`‚Ì“śŽîŚ–E‚©‚琏‚éŽîᇂƂ ‚é‚ȘC‰»Šw—Ă–@‚Ì—LŒű«‚ȘŠm—§‚”‚Ä‚š‚èC‚»‚ê‚Œ‚ê‚ÉĆ“K‰»‚ł‚ê‚œƒŒƒWƒƒ“‚Ș•W€ŽĄ—Ă‚Æ‚È‚Á‚Ä‚ą‚éDœŠO«Ewing “śŽî‚ɑ΂”‚ẮCœŒŽ”­‚ÌEwing “śŽî‚Æ“Ż‚¶ŽĄ—Ðí—Ș‚ȘÌ‚ç‚êCvincristineCdoxorubicinCcyclophosphamideiVDCj‚š‚æ‚ŃifosfamideCetoposideiIEj‚ÌŒđ‘ă—Ă–@‚Ș„§‚ł‚ê‚Ä‚ą‚émiT2C00532CEV level ⅡjCiT2F08392CEVlevel ⅡjnD‰Ą–ä‹Ű“śŽîŹŽ™—á‚Ƃ́C“]ˆÚ‚Ì—L–ł‚â”­¶•”ˆÊ‚È‚Ç‚ĆƒŠƒXƒN•Ș—Ț‚Șs‚í‚êCƒŠƒXƒN•Ê‚ÉŽĄ—ĂƒŒƒWƒƒ“‚Ș‹K’è‚ł‚ê‚Ä‚ą‚éDźŒ`ŠO‰È—̈æ‚Ćˆ”‚€ŽlŽˆ”­¶‚̉Ą–ä‹Ű“śŽî‚́C‚Ù‚Æ‚ń‚Ç‚Ș’†ŠÔƒŠƒXƒNŒQ‚É‘Š“–‚”vincristineCactinomycin DCcyclophosphamideiVACj3 Ü‚É‚æ‚郌ƒWƒƒ“‚Ș•W€‰»Šw—Ă–@‚Æ‚ł‚ê‚Ä‚ą‚é miT2C00398CEV level ⅡjCiT2F08399CEV level ⅡjnD

ˆê•ûC”ń‰~Œ`Ś–E“śŽî‚́C–aŽŒ`‚â‘œŒ`«‚̍Ś–E‚©‚琏‚éC•œŠŠ‹Ű“śŽîCˆ««üˆÛ«‘gD‹…ŽîCŠŠ–Œ“śŽî“™‚Ì“î•”ŽîᇂƂ ‚éD‰~Œ`Ś–E“śŽî‚æ‚è‚à‚Í‚é‚©‚É”­¶•p“x‚Ș‚‚ą‚ȘC‰»Šw—Ă–@‚ɑ΂·‚銎Žó«‚Í’á‚­C‚»‚Ì—LŒű«‚ɂ‚ą‚Ä‚Í‚ą‚Ü‚Ÿcontroversial ‚Èó‹”‚Ć‚ ‚éDŽèp‚É‚æ‚éŰœ‚Șą“ï‚Ȑis—á‚𒆐S‚ɉ»Šw—Ă–@‚ÌŽĄ—ĂŠJ”­‚Șs‚í‚ê‚Ä‚«‚œ‚ȘC”äŠrŽŽŒ±‚É‚š‚ą‚Ädoxorubicin ’PÜ‚đ’Ž‚Š‚鎥—ÐŹŃ‚đŽŠ‚”‚œƒŒƒWƒƒ“‚Í•ń‚ł‚ê‚Ä‚ą‚È‚ąD‚”‚œ‚Ș‚Á‚āC“î•”“śŽîis—á‚ɑ΂”‚ẮCdoxorubicin ’PÜ‚Ș•W€ŽĄ—Ă‚ÉˆÊ’u‚Ă‚Ż‚ç‚ê‚Ä‚ą‚émiT2C00168CEV level ⅠjCiT2F08223CEV level ⅣjnD‹ß”NC‚ą‚­‚‚©‚̐V‚”‚ąƒŒƒWƒƒ“‚â–òÜ‚Ì—LŒű«‚Ș‘æⅡ‘ŠŽŽŒ±‚É‚š‚ą‚ÄŽŠŽ‚ł‚ê‚Ä‚š‚èCĄŒă‚ÌŒŸŰ‚ȘŠú‘Ò‚ł‚ê‚éi“]ˆÚÇ—á‚ɂ‚ą‚Ä‚Í‘æ12 ÍCQ2 ‚đŽQÆjD

”ń‰~Œ`Ś–E“śŽî‚ÌŰœ‰Â”\‚È”ńis—á‚ÉŠÖ‚”‚ẮCąŠE“I‚É‚ÍŽèp‚Ș•W€ŽĄ—Ă‚Æ‚ł‚ê‚Ä‚ą‚é‚ȘC‹ß”Nƒƒ^ƒAƒiƒŠƒVƒX‚É‚æ‚Á‚Ädoxorubicin ‚š‚æ‚Ńifosfamide ‚É‚æ‚é•â•‰»Šw—Ă–@‚Ì—LŒű«‚ȘŽŠ‚ł‚ê‚Ä‚ą‚émiT2F09907CEV level ⅠjCiT2F04906CEV level ⅠjnD“Á‚ɍ‚ˆ««“x”ń‰~Œ`Ś–E“śŽî‚ÌŰœ‰Â”\‚ÈStage ⅢiAJCC 6th ed.j‚ÌŽlŽˆ”­¶—á‚ɂ‚ą‚Ă͉»Šw—Ă–@‚Ì—LŒű«‚Ș‚æ‚èŠú‘Ò‚Ć‚«‚邱‚Æ‚©‚çC•â•‰»Šw—Ă–@‚ÌŽÀŽ{‚đl—¶‚·‚Ś‚«‚Ć‚ ‚éD‚œ‚Ÿ‚”C‰»Šw—Ă–@‚ɍۂ”‚Ä‚Í—LŠQŽ–Û‚ɑ΂·‚钍ˆÓ‚Ș•K—v‚Ć‚ ‚èCŠłŽÒ‚Ì”N—î‚â‘Sgó‘Ô‚đl—¶‚”“K‰ž‚đŒˆ’è‚·‚Ś‚«‚Ć‚ ‚èCƒŠƒXƒN‚ƃxƒlƒtƒBƒbƒg‚ÉŠÖ‚·‚é\•Ș‚Èà–Ÿ‚đŠłŽÒ‚És‚Á‚œă‚ĆŽÀŽ{‚·‚Ś‚«‚Ć‚ ‚éD

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Ewing “śŽî‚ɑ΂·‚鉻Šw—Ă–@‚̃Gƒrƒfƒ“ƒX

  • Childrenfs Cancer GroupiCCGj/Pediatric Oncology GroupiPOGj‚́C518 —á‚Ì30 ÎˆÈ‰ș‚ÌEwing “śŽîÇ—á‚ɑ΂”Cvincristine, doxorubiciniadriamycinjCcyclophosphamideCactinomycin DiVACAj4 Ü‚É‚æ‚é•W€ŽĄ—Ă‚ÆCVACA ‚ÆifosfamideCetoposideiIEjŒđ‘ă—Ă–@‚É‚æ‚鎎Œ±ŽĄ—Ă‚Ìƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đs‚Á‚œD“]ˆÚ‚đ—L‚·‚é120 Ç—á‚ÉŠÖ‚”‚ẮC5 ”N–ł•a¶‘¶—Š‚š‚æ‚Ń‘S¶‘¶—Š‚Í•W€ŽĄ—ĂŒQ‚Ć‚»‚ê‚Œ‚ê22“‚š‚æ‚Ń35“CŽŽŒ±ŽĄ—ĂŒQ‚Ć22“‚š‚æ‚Ń34“‚Ć‚ ‚èC—ŒŒQŠÔ‚Ć—LˆÓ·‚ÍŒ©‚ç‚ê‚È‚©‚Á‚œip  0.81jDˆê•ûCŒÀ‹Ç«‚Ì398 Ç—á‚ÉŠÖ‚”‚ẮC5 ”N–ł•a¶‘¶—Š‚Ș•W€ŽĄ—ĂŒQ‚Ć54“CŽŽŒ±ŽĄ—ĂŒQ‚Ć69“ip  0.005jC5 ”N‘S¶‘¶—Š‚Í•W€ŽĄ—ĂŒQ‚Ć61“CŽŽŒ±ŽĄ—ĂŒQ‚Ć72“ip  0.01j‚ƁC‚ą‚ž‚ê‚àŽŽŒ±ŽĄ—ĂŒQ‚Ș—LˆÓ‚É—D‚ê‚Ä‚ą‚œDŒÀ‹Ç«Ewing “śŽî‚ɑ΂·‚鉻Šw—Ă–@‚Æ‚”‚ÄVACA { IE ‚Ș„§‚ł‚ê‚éiT2C00532CEV level ⅡjD
  • actinomycin D‚ÉŠÖ‚”‚Ä‚Í‚»‚Ì—LŒű«‚Ș‹^–⎋‚ł‚ê‚Ä‚š‚èC‚»‚ÌŒă‚̃ŒƒWƒƒ“‚©‚ç‚ÍŠO‚ł‚ê‚Ä‚ą‚éDCOG ‚́C“]ˆÚ‚Ì‚È‚ąEwing “śŽîÇ—á471 —á‚ɑ΂”CvincristineCdoxorubicinCcyclophosphamideiVDCj‚š‚æ‚ŃifosfamideCetoposideiIEjŒđ‘ă—Ă–@‚đ17 ƒTƒCƒNƒ‹48 T‚ƍs‚€•W€ŽĄ—Ă‚ÆCVDC { IE Œđ‘ă—Ă–@‚Ìdose intensity ‚đ‚‚ß11 ƒTƒCƒNƒ‹30 T‚ƍs‚€‹­‰»ŽĄ—Ă‚É‚æ‚郉ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đŽÀŽ{‚”‚œD‚»‚ÌŒ‹‰ÊC5 ”N–ł‘ˆ«¶‘¶—Š‚Ș•W€ŽĄ—ĂŒQ‚Ć72.1%i95%CI 65.8 `77.5%jC‹­‰»ŽĄ—ĂŒQ‚Ć70.1%i95%CI 63.9 `75.5%j‚Æ—LˆÓ·‚Ș”F‚ß‚ç‚ê‚È‚©‚Á‚œip  0.57jD5 ”N‘S¶‘¶—Š‚Ć‚àC•W€ŽĄ—ĂŒQ‚Ć80.5%i95%CI 74.7 `85.1%jC‹­‰»ŽĄ—ĂŒQ‚Ć77.0%i95%CI 71.1 `81.8%j‚Æ—LˆÓ·‚Ș”F‚ß‚ç‚ê‚È‚©‚Á‚œD‚”‚œ‚Ș‚Á‚āCŒÀ‹Ç«Ewing “śŽî‚ɑ΂·‚éVDC { IE Œđ‘ă—Ă–@‚É‚š‚ą‚āCdose intensity ‘‰Á‚̃ƒŠƒbƒg‚Í‚È‚©‚Á‚œ‚ÆŒ‹˜_‚Ă‚Ż‚ç‚ê‚œiT2F08392CEV level ⅠjD

‰Ą–ä‹Ű“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚̃Gƒrƒfƒ“ƒX

  • Intergroup Rhabdomyosarcoma Study GroupiIRSGj‚́C21ÎˆÈ‰ș‚Ì“]ˆÚ‚Ì‚È‚ą‰Ą–ä‹Ű“śŽîÇ—á‚ɑ΂”C•W€ŽĄ—Ă‚Ć‚ ‚évincristineCactinomycin DCcyclophosphamideiVAC ŒQj235 —áCvincristineCactinomycin DCifosfamideiVAI ŒQj222 —áC‚š‚æ‚ŃvincristineCactinomycin DCetoposideiVAE ŒQj236 —á‚Ì3 ŽĄ—ĂŒQ‚ɐU‚è•Ș‚Ż‚郉ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đŽÀŽ{‚”‚œiIRS-IVjD3 ”N–ł‘ˆ«¶‘¶—Š‚ÍVACŒQ75“CVAI ŒQ77“CVAE ŒQ77“‚Ć‚ ‚èCŠeŒQŠÔ‚Ć—LˆÓ·‚Í‚È‚©‚Á‚œip  0.42jD‚”‚œ‚Ș‚Á‚āC’†ŠÔƒŠƒXƒNŒQ‚̉Ą–ä‹Ű“śŽî‚ɑ΂·‚é•W€‰»Šw—Ă–@‚Æ‚”‚ẮCˆË‘R‚Æ‚”‚ÄVAC ƒŒƒWƒƒ“‚Ș„§‚ł‚ê‚éiT2C00398CEV level ⅡjD
  • Childrenfs Oncology GroupiCOGj‚́C50ÎˆÈ‰ș‚Ì’†ŠÔƒŠƒXƒNŒQ‚̉Ą–ä‹Ű“śŽî617 —á‚ɑ΂·‚é•W€ŽĄ—ĂVAC ‚ÆVAC ‚š‚æ‚ŃvincristineCtopotecanCcyclophosphamideiVTCjŒđ‘ă—Ă–@iVAC/VTCj‚ÌŽŽŒ±ŽĄ—Ă‚É‚æ‚郉ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đŽÀŽ{‚”‚œD‚»‚ÌŒ‹‰ÊC4 ”N–ł‘ˆ«¶‘¶—Š‚ȘVAC ŒQ‚Ć73“CVAC/VTC ŒQ‚Ć68“‚Æ—LˆÓ·‚Ș”F‚ß‚ç‚ê‚È‚©‚Á‚œip  0.3jD‚æ‚Á‚āC‚±‚ÌŽŽŒ±‚É‚š‚ą‚Ä‚àVAC ƒŒƒWƒƒ“‚Ș’†ŠÔƒŠƒXƒNŒQ‚̉Ą–ä‹Ű“śŽî‚ɑ΂·‚é•W€ŽĄ—Ă‚ÆŒ‹˜_‚Ă‚Ż‚ç‚ê‚Ä‚ą‚éiT2F08399CEV level ⅡjD

”ń‰~Œ`Ś–E“śŽîis—á‚ɑ΂·‚鉻Šw—Ă–@‚̃Gƒrƒfƒ“ƒX

  • “î•”“śŽîis—á‚ɑ΂·‚édoxorubicin’PÜ‚Ædoxorubicin‚đŠÜ‚Ț•č—p‰»Šw—Ă–@‚Ì8 ‚‚̃‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚É“o˜^‚ł‚ê‚œ2,281 —á‚̃ƒ^ƒAƒiƒŠƒVƒX‚ÌŒ‹‰Ê‚Ș•ń‚ł‚ê‚œD‰»Šw—Ă–@‚ɑ΂·‚éresponse rate ‚́Cfixed effect model ‚É‚æ‚é‰đÍ‚Ƃ́C•č—p‰»Šw—Ă–@‚É‚š‚ą‚Ädoxorubicin ’PÜ‚æ‚è‚à—LˆÓ‚ɍ‚‚©‚Á‚œiodds ratio 1.29,95%CI 1.03 `1.60, p  0.03jD‚”‚©‚”Crandom effect model ‚É‚æ‚é‰đÍ‚Ƃ́C—ŒŒQŠÔ‚Ćresponse rate ‚Ì—LˆÓ·‚͏ÁŽž‚”‚œiodds ratio 1.26, 95%CI 0.96 `1.67, p 0.10jD‚Ü‚œC1 ”NŽ€–S—Šiodds ratio 0.87, 95%CI 0.73 `1.05, p  0.14j‚š‚æ‚Ń2 ”NŽ€–S—Šiodds ratio 0.84, 95%CI 0.67 `1.06, p  0.13j‚ÉŠÖ‚”‚Ä‚àC—ŒŽĄ—ĂŒQŠÔ‚Ć—LˆÓ·‚Í”F‚ß‚ç‚ê‚È‚©‚Á‚œD‚”‚œ‚Ș‚Á‚āCdoxorubicin ’PÜ‚ɑ΂·‚é•č—p‰»Šw—Ă–@‚Ì—D‰z«‚Í”F‚ß‚ç‚ê‚žC“î•”“śŽîis—á‚É‚š‚ą‚Ä‚Ídoxorubicin ’PÜ‚Ș„§‚ł‚ê‚éiT2C00168CEV level ⅠjD
  • European Organization for Clinical and Treatment of CanceriEORTCj‚ĆŽÀŽ{‚ł‚ê‚œC“î•”“śŽîis—á‚ɑ΂·‚éanthracycline ‚𒆐S‚Æ‚”‚œ‰»Šw—Ă–@‚Ì5 ‚‚̃‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đŠÜ‚Ț7 —Տ°ŽŽŒ±C2,185 —á‚ɂ‚ą‚Ä‚ÌŒă‚ëŒü‚«‰đÍŒ‹‰Ê‚Ș•ń‚ł‚ê‚œDƒ‰ƒ“ƒ_ƒ€‰»ŽŽŒ±‚É‚š‚ą‚ẮCdoxorubicin ’PÜ‚Æepirubicine ’PÜ‚Ì”äŠrCdoxorubicin { dacarbazine { cyclophosphamide { vincrintineiCYVADICj‚Ì4 TƒTƒCƒNƒ‹“Š—^‚Æ8 TƒTƒCƒNƒ‹“Š—^‚Ì”äŠrCdoxorubicin ’PÜ‚Ædoxorubicin { ifosfamide ‚š‚æ‚ŃCYVADIC 3 ŒQ‚Ì”äŠrCdoxorubicin ’PÜ‚Æepirubicine ’PÜCepirubicine ’PÜ•ȘŠ„“Š—^3 ŒQ‚Ì”äŠrCdoxorubicin { ifosfamide •W€—Ê‚Ædoxorubicin { ifosfamide ‘—Ê‚Ì”äŠr‚Șs‚í‚ê‚Ä‚ą‚œD‰»Šw—Ă–@‚É‚æ‚éŽîᇏkŹ‚Ìresponse rate ‚Ƃ́CCYVADIC ‚Ì4 TƒTƒCƒNƒ‹‚Æ8 TƒTƒCƒNƒ‹‚Ì”äŠrŽŽŒ±‚ƁC4 TƒTƒCƒNƒ‹“Š—^ŒQ‚Ș—LˆÓ‚É—D‚Á‚Ä‚ą‚œi34% vs 15%, p  0.001jD‚”‚©‚”C—LˆÓ·‚Ș”F‚ß‚ç‚ê‚œ‚Ì‚Í‚±‚Ì1 ŽŽŒ±‚Ì‚Ę‚Ć‚ ‚èC‚»‚Ì‘Œ‚Ì”äŠrŽŽŒ±‚É‚š‚ą‚Ă̓ŒƒWƒƒ“ŠÔ‚Ćresponse rate ‚Ì—LˆÓ·‚Í‚Ę‚ç‚ê‚È‚©‚Á‚œD¶‘¶‚ÉŠÖ‚”‚Ä‚àC‚·‚Ś‚Ä‚Ì”äŠrŽŽŒ±‚ĆƒŒƒWƒƒ“ŠÔ‚Ì—D—ò‚Ș”F‚ß‚ç‚ê‚žCdoxorubicin ’PÜ‚đă‰ń‚é—LŒű«‚ÍŽŠ‚ł‚ê‚È‚©‚Á‚œiT2F08223CEV level ⅣjD

”ń‰~Œ`Ś–E“śŽî‚ɑ΂·‚é•â•‰»Šw—Ă–@‚̃Gƒrƒfƒ“ƒX

  • Sarcoma Meta-analysis CollaborationiSMACj‚É‚æ‚éCŒÀ‹Ç«“î•”“śŽî‚ɑ΂·‚édoxorubicin ‚đŠÜ‚Ț•â•‰»Šw—Ă–@‚Ì14 ”äŠrŽŽŒ±1,568 —á‚đW‚ß‚œƒƒ^ƒAƒiƒŠƒVƒX‚ÌŒ‹‰Ê‚Ș•ń‚ł‚ê‚œD•â•‰»Šw—Ă–@‚́C‹ÇŠÄ”­‚̏oŒ»ŽžŠúihazard ratio 0.73,95%CI 0.56 `0.94, p  0.016jC‰“Šu“]ˆÚ‚̏oŒ»ŽžŠúihazard ratio 0.70, 95%CI 0.57`0.85, p  0.0003j‚đ—LˆÓ‚É’x‚ç‚čC–ł•a¶‘¶ŠúŠÔ‚đ—LˆÓ‚ɉ„’·‚”‚Ä‚ą‚œihazard ratio 0.75, 95%CI 0.64 `0.87, p  0.0001jD10 ”N–ł•a¶‘¶—Š‚ÍŽèp’P“Æ‚Ć45%C•â•‰»Šw—Ă–@‚Ć55% ‚Ć‚ ‚èCabsolute benefit ‚Í10%i95%CI 5 `15%j‚Ć‚ ‚邱‚Æ‚ȘŽŠ‚ł‚ê‚œD‚”‚©‚”C‘S¶‘¶‚ɂ‚ą‚Ä‚Í—ŒŒQŠÔ‚Ć—LˆÓ·‚Ș”F‚ß‚ç‚ê‚È‚©‚Á‚œihazard ratio 0.89, 95%CI 0.76 `1.03, p  0.12jD•â•‰»Šw—Ă–@‚Ì10 ”N¶‘¶—Š‚ɑ΂·‚éabsolute benefit ‚Í4%i95%CI 1 `9%j‚Ć‚ ‚Á‚œDˆê•ûCŽlŽˆ”­¶—á‚Ì‚Ę‚ÌƒTƒuƒOƒ‹[ƒv‰đÍ‚Ƃ́C•â•‰»Šw—Ă–@‚É‚æ‚è‘S¶‘¶‚à—LˆÓ‚ɉü‘P‚”ihazard ratio 0.80,p  0.029jC‚»‚Ìabsolute benefit ‚Í7% ‚Ć‚ ‚Á‚œDŽlŽˆ”­¶—á‚ɂ͕⏕‰»Šw—Ă–@‚Ș‚æ‚è—LŒű‚Ć‚ ‚邱‚Æ‚ȘŽŠŽ‚ł‚ê‚œiT2F09907CEV level ⅠjD
  • ‚»‚ÌŒăCSMACˆÈ~‚ɍs‚í‚ê‚œ“î•”“śŽî‚ɑ΂·‚é•â•‰»Šw—Ă–@‚Ì4‚‚̃‰ƒ“ƒ_ƒ€ ‰»”äŠrŽŽŒ±‚ÌŒ‹‰Ê‚đ’ljÁ‚”‚œCƒƒ^ƒAƒiƒŠƒVƒX‚̃Aƒbƒvƒf[ƒg‚Șs‚í‚ê‚œD‚±‚̃ƒ^ƒAƒiƒŠƒVƒX‚Ć‚Í18 ”äŠrŽŽŒ±‚ȘŒŸ“ą‚ł‚êC1,953 —á‚Ș‰đÍ‘ΏۂƂł‚ê‚œD‰“Šu“]ˆÚ‚đŠÜ‚ȚÄ”­‚ÉŠÖ‚”‚ẮC•â•‰»Šw—Ă–@‚É‚æ‚è—LˆÓ‚ÉŒž­‚”‚Ä‚š‚èCSMAC ‚ĆŽŠ‚ł‚ê‚œ–ł•a¶‘¶ŠúŠÔ‚̉„’·‚ȘŠm”F‚ł‚ê‚œirelative riskFRR 0.67, 95%CI 0.56`0.82, p  0.0001jD‚Ü‚œCSMAC ‚Ć‚à•ń‚ł‚ê‚œ‚Æ‚š‚èCdoxorubicin ‚𒆐S‚Æ‚”ifosfamide‚đŠÜ‚Ü‚È‚ą•â•‰»Šw—Ă–@‚Ƃ́C—LˆÓ‚È‘S¶‘¶ŠúŠÔ‚̉ü‘P‚Í“Ÿ‚ç‚ê‚Ä‚ą‚È‚©‚Á‚œiRR 0.84, 95%CI 0.68 `1.03, p  0.09jD‚”‚©‚”Canthracyclineidoxorubicin ‚Ü‚œ‚Íepirubicinj‚Æifosfamide •č—p‚É‚æ‚é•â•‰»Šw—Ă–@‚̐V‚”‚ą4 ”äŠrŽŽŒ±‚É‚š‚ą‚ẮCRR 0.56i95%CI 0.36 `0.85j‚Ć—LˆÓ‚É‘S¶‘¶‚̉ü‘P‚Ș”F‚ß‚ç‚ê‚œip 0.01jD‚±‚Ì4 ŽŽŒ±‚đŠÜ‚ß‚œ18 ”äŠrŽŽŒ±‘S‘Ì‚Æ‚”‚Ä‚àC•â•‰»Šw—Ă–@‚É‚æ‚é‘S¶‘¶‚̉ü‘P‚Í—LˆÓ‚Ć‚ ‚Á‚œiRR 0.77, 95%CI 0.64 `0.93, p  0.01jD‚Ü‚œC•â•‰»Šw—Ă–@‚É‚æ‚éÄ”­‚Ìabsolute risk ‚ÌŒyŒž‚Í10%i95%CI 5 `15%jCŽ€–S‚Ìabsolute risk ‚ÌŒyŒž‚Í6%i95%CI 2 `11%j‚Ć‚ ‚Á‚œ‚ȘCanthracycline ‚Æifosfamide •č—p‚Ƃ́CŽ€–S‚Ìabsolute risk ‚ÌŒyŒž‚Í11%i95%CI 3 `19%j‚Æifosfamide ‚đ‰Á‚Š‚邱‚Æ‚Ć‘S¶‘¶‚ÉŠÖ‚·‚éăæ‚čŒű‰Ê‚Ș”F‚ß‚ç‚ê‚œDŰœ‰Â”\‚È“î•”“śŽî‚ɑ΂”‚ẮCanthracycline ‚Æifosfamide •č—p‚̕⏕‰»Šw—Ă–@‚Ș—LŒű‚Ć‚ ‚éD‚”‚©‚”C‚»‚ÌŽÀŽ{‚ɍۂ”‚Ä‚Í—LŠQŽ–Û‚ɂ‚ą‚Ä‚à’ˆÓ‚đ•„‚€•K—v‚Ș‚ ‚éiT2F04906CEV level ⅠjD
y•¶@ŒŁz
1j T2C00532
Grier HE, Krailo MD, Tarbell NJ et alFAddition of ifosfamide and etoposide to standard chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med 2003G348i8jF694-701@mEV level Ⅱn
2j T2F08392
Granowetter L, Womer R, Devidas M et alFDose-intensified compared with standard chemotherapy for nonmetastatic Ewing sarcoma family of tumorsF a Children's Oncology Group Study. J Clin Oncol 2009G27i15jF2536-2541@mEV level Ⅱn
3j T2C00398
Crist WM, Anderson JR, Meza JL et alFIntergroup rhabdomyosarcoma study-IVFresults for patients with nonmetastatic disease. J Clin Oncol 2001G 19i12jF3091-3102@mEV level Ⅱn
4j T2F08399
Arndt CA, Stoner JA, Hawkins DS et alFVincristine, actinomycin, and cyclophosphamide compared with vincristine, actinomycin,and cyclophosphamide alternating with vincristine, topotecan, and cyclophosphamide for intermediate-risk rhabdomyosarcomaFchildren's oncology group study D9803. J Clin Oncol 2009G27i31jF5182-5188@mEV level Ⅱn
5j T2C00168
Bramwell V, Anderson D, Charette M et alFDoxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database 2001i4jF CD003293@mEV level Ⅰn
6j T2F08223
Van Glabbeke M, van Oosterom AT, Oosterhuis JW et alFPrognostic factors for the outcome of chemotherapy in advanced soft tissue sarcomaF an analysis of 2,185 patients treated with anthracycline-containing first-line regimens--a European Organization for Clinical and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study. J Clin Oncol 1999G17i1jF150-157@mEV Level Ⅳn
7j T2F09907
Anonymous. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adultsFmeta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet 1997G350i9092jF1647-1654@mEV level Ⅰn
8j T2F04906
Pervaiz N, Colterjohn N, Farrokhyar F et alFA systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008G113i3jF573-581@mEV level Ⅰn

CQ 2
‰»Šw—Ă–@‚ÌŒű‰Ê”»’è‚Ì•û–@‚Í
—v–ń
Grade C
 
 
“î•”“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚ÌŒű‰Ê”»’è‚đs‚€‚±‚Ƃ͉ż’l‚Ș‚ ‚éD‰»Šw—Ă–@‚ÌŒű‰Ê”»’è‚ɂ́CŽîᇐۏœ•W–{‚É‚š‚Ż‚é‘gDŠw“I‰óŽ€—ŠC‰æ‘œă‚ÌŽîᇃTƒCƒYkŹ—ŠCfluorodeoxyglucose-positron emission tomographyiFDG-PETj‚É‚æ‚éŽîᇓœ‘ăŽÓ‚Ì’á‰ș—Š“™‚Ș—p‚ą‚ç‚ê‚Ä‚ą‚éD
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‰»Šw—Ă–@‚ÌŽÀŽ{‚É“–‚œ‚Á‚ẮC‚»‚ÌŒű‰Ê‚đ“KŰ‚É•]‰ż‚·‚邱‚Æ‚Șd—v‚Ć‚ ‚éD“î•”“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚ÌŒű‰Ê”»’è‚ɂ́CŽîᇐۏœ•W–{‚É‚š‚Ż‚é‘gDŠw“I‰óŽ€—Š‚Ì—L—p«‚ȘŽŠŽ‚ł‚ê‚Ä‚ą‚éiT2F08260CEV level ⅣjD‚”‚©‚”C‘gDŠw“I‰óŽ€—Š‚Ș—\Œă‚Æ‘ŠŠÖ‚”‚Ä‚ą‚È‚©‚Á‚œ‚Æ‚·‚é•ń‚à‚ ‚èC“î•”“śŽî‚ɑ΂·‚鉻Šw—Ă–@‚ÌŒű‰Ê”»’è–@‚Æ‚”‚ẮCœ“śŽî‚̏ꍇ‚Ù‚Ç•]‰ż‚Ș’è‚Ü‚Á‚Ä‚Í‚ą‚È‚ąD

‚Ü‚œC‚±‚ê‚Ü‚Ć‚ÉWHO ‹K€‚âRECIST ‹K€‚É‚æ‚é‰æ‘œă‚ÌŽîᇏkŹ—ŠmiT2F08223CEV level Ⅳ jCiT2F08368CEV level Ⅳ jnCƒ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚É‚š‚Ż‚éWÏ‚Ì’á‰ș“™‚Ì—L—p«‚Ș˜_‚¶‚ç‚ê‚Ä‚«‚œ‚ȘC’Tő“I‚ĆŒă‚ëŒü‚«‚ÌŒ€‹†•ń‚Ș‘œ‚­CŒ‹‰Ê‚àˆê’è‚Ć‚Í‚È‚ąD‹ß”NCFDG-PET ‚É‚æ‚éŽîᇂ̓œ‘ăŽÓ”\‚ÌŒž­—Š‚Ș‰»Šw—Ă–@‚ÌŒű‰Ê”»’è‚É—L—p‚Æ‚·‚é•ń‚Ș‘œ”‚È‚ł‚ê‚Ä‚š‚èCĄŒă‚ÌŒŸŰ‚ȘŠú‘Ò‚ł‚ê‚Ä‚ą‚éiT2F05288CEV level ⅣjDiƒ^ƒŠƒEƒ€ƒVƒ“ƒ`ƒOƒ‰ƒtƒB[‚š‚æ‚ŃFDG-PET ‚ɂ‚ą‚Ä‚Í‘æ4 ÍCQ6 ‚š‚æ‚ŃCQ7 ‚àŽQÆjD

‚±‚ê‚ç‚̉摜‚É‚æ‚éŒű‰Ê”»’è‚Ƃ́C¶–œ—\Œă‚Ć‚Í‚È‚­Žîᇉ󎀗Š‚Æ‚ÌŠÖŒW‚đ˜_‚¶‚œ‚à‚Ì‚Ș‘œ‚ą‚ȘC—L—p«‚ÌŒŸŰ‚Ì‚œ‚߂ɍĄŒă‚͐¶‘¶ŠúŠÔ‚đend point ‚Æ‚”‚œ‘OŒü‚«‚È—Ő°Œ€‹†‚Ì’~Ï‚Ș•K—v‚Ć‚ ‚éD

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  • “î•”“śŽî‚ɑ΂·‚édoxorubicin‚𒆐S‚Æ‚”‚œp‘O‰»Šw—Ă–@C•úŽËü—Ă–@‚š‚æ‚ŃŽèp‚É‚æ‚é—Տ°ŽŽŒ±‚É“o˜^‚”C‘gDŠw“IŒű‰Ê”»’è‚đs‚Á‚œ496 —á‚̉đÍ‚ƁCŰœ•W–{‚É‚š‚Ż‚é95“ˆÈă‚ÌŽîᇉ󎀗Š‚Ș“Ÿ‚ç‚ê‚Ä‚ą‚œŒQ‚Ƃ́C‰óŽ€—Š95% –ą–ž‚ÌŒQ‚É”äŠr‚”‚Ä—LˆÓ‚ɐ¶–œ—\Œă‚Ș‰ü‘P‚”‚Ä‚ą‚œ‚±‚Æ‚Ș•ń‚ł‚ê‚œD10 ”N¶‘¶—Š‚ÍŽîᇉ󎀗Š95“ˆÈăŒQ‚Ć71“C95% –ą–žŒQ‚Ć‚Í55“‚Ć‚ ‚èip  0.0001jCrelative riskiRRj‚Í1.86 ‚Ć‚ ‚Á‚œD‚Ü‚œC10 ”N‹ÇŠÄ”­—Š‚ÉŠÖ‚”‚Ä‚àC‰óŽ€—Š95“ˆÈăŒQ‚Ć11“C95% –ą–žŒQ‚Ć‚Í23% ‚ƁC‰óŽ€—Š95“ˆÈăŒQ‚Ć—LˆÓ‚ɋǏŠÄ”­‚Ș—}§‚ł‚ê‚Ä‚ą‚œip  0.0018jDRR ‚Í2.51 ‚Ć‚ ‚Á‚œiT2F08260CEV level ⅣjD
  • European Organization for Clinical and Treatment of CanceriEORTCj‚ĆŽÀŽ{‚ł‚ê‚œ5 ‚‚̃‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚đŠÜ‚Ț7 ‚Â‚Ì—Ő°ŽŽŒ±‚É“o˜^‚”‚œ“î•”“śŽîis—á2,185 —á‚đ‘ΏۂɁCanthracycline ‚𒆐S‚Æ‚”‚œ‰»Šw—Ă–@‚ɑ΂·‚éWHO ‹K€‚É‚æ‚é‰æ‘œă‚Ì‘tŒű‚Ɛ¶–œ—\Œă‚Æ‚ÌŠÖ˜A‚ɂ‚ą‚ẲđÍ‚Ș‚È‚ł‚ê‚Ä‚ą‚éD”äŠrŽŽŒ±‚É‚š‚ą‚ẮC1 ŽŽŒ±‚đœ‚«ƒŒƒWƒƒ“‚Ìˆá‚ą‚É‚æ‚Á‚ĉ摜ă‚Ì‘tŒű—Š‚É—LˆÓ·‚ÍŒ©‚ç‚ê‚È‚©‚Á‚œ‚ȘC‘tŒű—Š‚É—LˆÓ·‚Ș‚ ‚Á‚œŽŽŒ±‚àŠÜ‚߁C¶‘¶ŠúŠÔ‚Ì—LˆÓ·‚Í”F‚ß‚ç‚ê‚È‚©‚Á‚œDŠź‘S‘tŒű‚Æ•”•Ș‘tŒű‚đ‡‚í‚č‚œ‰æ‘œf’f‚É‚æ‚é‘tŒű—Š‚Í26“‚Ć‚ ‚èC‘SÇ—á‚̐¶‘¶ŠúŠÔ‚Ì’†‰›’l‚Í51 T‚Ć‚ ‚Á‚œD‰»Šw—Ă–@‚ɑ΂·‚é‘tŒű‚Ɛ¶‘¶‚ɉe‹ż‚đ—^‚Š‚éˆöŽq‚đƒƒWƒXƒeƒBƒbƒN‰ń‹A•ȘÍ‚š‚æ‚ŃCox ‰ń‹A•ȘÍ‚É‚æ‚é‘œ•Ï—ʉđÍ‚Ć‚»‚ê‚Œ‚ꌟ’è‚”‚œŒ‹‰ÊC—ŒŽÒ‚͈ê’v‚č‚žC‚Ț‚”‚ë‹t‚̉e‹ż‚đ—^‚Š‚éˆöŽq‚à‘¶Ę‚”‚œD‚±‚ÌŒ‹‰Ê‚́CˆÙ‚È‚é—\ŒăˆöŽq‚đŽ‚Â‰»Šw—Ă–@‚ɑ΂·‚é‘tŒű‚Ɛ¶‘¶ŠúŠÔ‚Í•K‚ž‚”‚àˆê’v‚”‚È‚ą‚±‚Æ‚đŽŠ‚”‚Ä‚š‚èC‰æ‘œ‚É‚æ‚éŒű‰Ê”»’è‚É‚æ‚é—\Œă—\‘Ș‚Șą“ï‚Ć‚ ‚邱‚Æ‚ȘŽŠŽ‚ł‚ê‚œDV‚”‚ąRŠàÜ‚đ—p‚ą‚œ—Տ°ŽŽŒ±‚É‚š‚ą‚ẮC‰æ‘œ‚É‚æ‚é‘tŒű—Š‚ĆŒű‰Ê”»’è‚đs‚€ê‡‚Ș‘œ‚ą‚ȘCŒ‹‰Ê‚̉đŽß‚É‚Í’ˆÓ‚·‚é•K—v‚Ș‚ ‚éiT2F08223CEV level ⅣjD
  • Burke‚ç‚́CIntergroup Rhabdomyosarcoma StudyiIRSj‡W—Տ°ŽŽŒ±‚É“o˜^‚ł‚ꓱ“ü‰»Šw—Ă–@‚ȘI—č‚”‚œ‰Ą–ä‹Ű“śŽîÇ—á444 —á‚đ‘ΏۂɁCŽĄ—ĂŠJŽnŒă8 TŽž“_‚Ć‚ÌWHO ‹K€‚É‚æ‚é‰æ‘œă‚Ì‘tŒű‚Ɛ¶–œ—\Œă‚Æ‚Ì‘ŠŠÖ‚ÉŠÖ‚·‚é‰đÍŒ‹‰Ê‚đ•ń‚”‚Ä‚ą‚éD‘S‘Ì‚Ì‘tŒű—Š‚Í77“i95%CI 73 `81%j‚Ć‚ ‚èC“à–ó‚Ícomplete responseiCRj21“Cpartial responseiPRj56% ‚Ć‚ ‚Á‚œDˆê•ûC5 ”N–ł‘ˆ«¶‘¶—Š‚ÍCR ŒQ‚Ć75“CPRŒQ‚Ć71“Cno responseŒQ‚Ć78%‚Ć‚ ‚èC—LˆÓ·‚Í”F‚ß‚ç‚ê‚È‚©‚Á‚œip  0.57jD‚Ü‚œCƒTƒuƒOƒ‹[ƒv‰đÍ‚ƁC•úŽËüŽĄ—Ă‚ÌŽžŠú‚â‘gDŒ^•Ê‚Ć‚à‘tŒű—Š‚Æ5”N–ł‘ˆ«¶‘¶—Š‚ÌŠÖ˜A‚ɂ‚ą‚ÄŒŸ“ą‚”‚œ‚ȘC‚ą‚ž‚ê‚̃TƒuƒOƒ‹[ƒv‚É‚š‚ą‚Ä‚à‰æ‘œ‚É‚æ‚é‘tŒű—Š‚Í–ł‘ˆ«¶‘¶—Š‚ɉe‹ż‚”‚Ä‚ą‚È‚©‚Á‚œiT2F08368CEV level ⅣjD
  • Benz‚ç‚́C“î•”“śŽî‚ɑ΂·‚ép‘O‰»Šw—Ă–@‚Ì‘OŒü‚«ŽŽŒ±‚đs‚ąCFDG-PET/CT‚đ—p‚ą‚œŽîᇑgD‚Ì“œ‘ăŽÓ”\‚Ì‘Ș’è‚É‚æ‚Á‚ďp‘O‰»Šw—Ă–@‚ÌŒű‰Ê‚Ș”»’è‰Â”\‚©ŒŸ“ą‚”‚œD50 —á‚ÌŰœ‰Â”\‚È“î•”“śŽîŠłŽÒ‚Ș‚±‚ÌŽŽŒ±‚É“o˜^‚”Cifosfamide ‚𒆐S‚Æ‚”‚œp‘O‰»Šw—Ă–@‚đŽÀŽ{‚ł‚ê‚œDp‘O‰»Šw—Ă–@‚ÌŠJŽn‘OC1 ƒTƒCƒNƒ‹I—čŒăCp‘O‰»Šw—Ă–@I—čŒă‚ĆFDG-PET/CT ‚đŽB‰eCFDG Žæ‚荞‚Ę‚Ì•Ï‰»‚đ‘Ș’è‚”CŰœ•W–{‚ÌŽîᇉ󎀗Š‚Æ‚ÌŠÖ˜A‚đ’Č‚Ś‚œD‘gDŠw“I‚ÈŒŸ“ą‚Ƃ́CŽîᇉ󎀗Š‚Ș95“ˆÈă‚Ć‚ ‚Á‚œ‚Ì‚Í50 —á’†8 —áiresponderjC95“–ą–ž‚Ć‚ ‚Á‚œÇ—á‚Í42 —áinonresponderj‚Ć‚ ‚èC‘gDŠw“I‘tŒű—Š‚Í16“‚Ć‚ ‚Á‚œDŽĄ—Ă‘O‚Æ”äŠr‚”C‰»Šw—Ă–@1 ƒTƒCƒNƒ‹I—čŒăi‘Šú”»’èj‚Ć‚ÌFDG Žæ‚荞‚Ę’á‰ș—Š‚Ș35“ˆÈă‚Ć‚ ‚ê‚΁C‘gDŠw“IŒű‰Ê‚đŠŽ“x100“C“ÁˆÙ“x67“‚Ć”œ‰f‚”‚Ä‚ą‚œD‚Ü‚œC‰»Šw—Ă–@I—莞iŒăŠú”»’èj‚É‚š‚Ż‚éFDG Žæ‚荞‚Ę’á‰ș—Š‚Ș60“ˆÈă‚Ć‚ ‚ê‚΁CŠŽ“x88“C“ÁˆÙ“x68“‚Ć‘gDŠw“IŒű‰Ê‚đ”œ‰f‚”‚Ä‚ą‚œD‚”‚œ‚Ș‚Á‚āC–{Œ€‹†‚Ƃ́CFDG Žæ‚荞‚Ę’á‰ș—Š‚Ș35“ˆÈă‚Æ‚ą‚€ƒJƒbƒgƒIƒt’l‚đ—p‚ą‚āC1 ƒTƒCƒNƒ‹I—莞“_‚Æ‚ą‚€‘Šú‚É“î•”“śŽî‚ɑ΂·‚ép‘O‰»Šw—Ă–@‚Ì‘gDŠw“IŒű‰Ê‚đ—\‘Ș‰Â”\‚Ć‚ ‚éC‚ÆŒ‹˜_‚ł‚ê‚œiT2F05288CEV level ⅣjD
y•¶@ŒŁz
1j T2F08260
Eilber FC, Rosen G, Eckardt J et alFTreatment-induced pathologic necrosisFa predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas. J Clin Oncol 2001G19i13jF3203-3209@mEV Level Ⅳn
2j T2F08223
Van Glabbeke M, van Oosterom AT, Oosterhuis JW et alFPrognostic factors for the outcome of chemotherapy in advanced soft tissue sarcomaF an analysis of 2,185 patients treated with anthracycline-containing first-line regimens--a European Organization for Clinical and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study. J Clin Oncol 1999G17i1jF150-157@mEV Level Ⅳn
3j T2F08368
Burke M, Anderson JR, Kao SC et alFAssessment of response to induction therapy and its influence on 5-year failure-free survival in group Ⅲ rhabdomyosarcomaFthe Intergroup Rhabdomyosarcoma Study-IV experience--a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. J Clin Oncol 2007G25i31jF4909-4913@mEV Level Ⅳn
4j T2F05288
Benz MR, Czernin J, Allen-Auerbach MS et alFFDG-PET/CT imaging predicts histopathologic treatment responses after the initial cycle of neoadjuvant chemotherapy in high-grade soft-tissue sarcomas. Clin Cancer Res 2009G15i8jF2856-2863@mEV Level Ⅳn

‘æ10 Í@“î•”“śŽî‚Ì•úŽËüŽĄ—Ă

Clinical QuestionE„§ˆê——‚Ö


CQ 1
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Grade B
“KŰ‚ÈŰœ‰‚Ć‚È‚ą“î•”“śŽî‚ÌŽèp‚ÉŠÖ‚”‚Ä•úŽËüŽĄ—Ă‚Ì•č—p‚͋ǏŠÄ”­—Š‚đ’á‰ș‚ł‚č‚éD
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  • ‚»‚Ì‘Œ‚ą‚­‚‚©‚ÌŒă‚ëŒü‚«Œ€‹†‚Ć‚à•Ó‰Űœ‚Ü‚œ‚͈ꕔŰœ’f’[—z«‚̏ꍇC•úŽËüŽĄ—Ă‚Ș‹ÇŠ§Œä‚É—LŒű‚Ć‚ ‚éƒf[ƒ^‚ȘŽŠ‚ł‚ê‚Ä‚ą‚émiT2F06014CEV level ⅣjCiT2F06050CEV level ⅣjnD‚”‚©‚”Žîᇂ©‚ç1 cm ˆÈă‚ÌŰœ‰‚ȘŠm•Û‚ł‚ê‚Ä‚ą‚ê‚ΕúŽËüŽĄ—Ă‚đ•č—p‚”‚È‚­‚Æ‚à—ǍD‚ȋǏŠ§Œä—Ši36 —á’†10 ”N‚ÌŠÏŽ@ŠúŠÔ‚ĆÄ”­‚È‚”j‚Ș’BŹ‚ł‚ê‚é‚Æ‚Ì•ń‚Ș‚ ‚éiT2F12455CEV level ⅣjD
  • ”ń‰~Œ`Ś–E“śŽî‚Ì‘gDŒ^‚Æ•úŽËüŠŽŽó«‚ɂ‚ą‚āC”S‰tŒ^Ž‰–b“śŽî‚Í‘Œ‚Ì”ń‰~Œ`Ś–E“śŽî‚ɔ䂔‚Ä•úŽËüŠŽŽó«‚̍‚‚ą‚±‚Æ‚đŽŠŽ‚·‚éŒă‚ëŒü‚«Œ€‹†‚Ș‘¶Ę‚·‚éDŽèp‚Æ•úŽËüŽĄ—Ă‚đ•č—p‚”‚œŽlŽˆ‚Ì“î•”“śŽî‚ÉŠÖ‚”‚Ä”S‰tŒ^Ž‰–b“śŽî‚Í‚»‚Ì‘Œ‚Ì“î•”“śŽî‚ɔ䂔‚Ä5 ”N‹ÇŠ§Œä—Š97.7% ‘Î89.6“‚Æ—LˆÓ‚É—D‚ê‚œŹŃ‚Ć‚ ‚Á‚œiT2F04915CEV level ⅣjD
  • ‰»Šw—Ă–@‚š‚æ‚Ń•úŽËüŽĄ—Ă‚ÌŒű‰Ê‚Ș‚‚ą‚Æ‚ł‚ê‚é‰~Œ`Ś–E“śŽîC‰Ą–ä‹Ű“śŽî‚ÆEwing “śŽî‚ɂ‚ą‚ẮCŽèpŽ{s‚È‚”‚Ć‚à‰»Šw—Ă–@‚Æ‚Ì•č—p‚ƍȘŽĄ‚ȘŠú‘Ò‚Ć‚«‚é•ń‚Ș‚ ‚éD“śŠá“IŽîᇎc‘¶‚Ì‚ ‚鉥–ä‹Ű“śŽî‚ɑ΂”‚ĉ»Šw—Ă–@‚Æ•úŽËüŽĄ—Ă‚ĆŽĄ—Ă‚”‚œê‡CŽè‘«‚̉Ą–ä‹Ű“śŽîi9.7 ”N‚Ì’†‰›’lŒo‰ßŠÏŽ@j‚Ć‚Í11 —á‚Ć‘S—á‹ÇŠÄ”­‚Í‚È‚©‚Á‚œiT2F12453CEV level ⅢjD‚Ü‚œŽlŽˆ‚ÉŒÀ’è‚č‚žŠç–Ê‚È‚Ç‚đŠÜ‚ß‚œ‘Sg‚̉Ą–ä‹Ű“śŽî‚ɂ‚ą‚ĉ»Šw—Ă–@‚Æ•úŽËüŽĄ—Ă•č—p‚Ì5 ”N–ł•a¶‘¶—Š70% ‚Æ‚Ì•ń‚Ș‚ ‚éiT2C00342CEV level ⅣjDœ‚Æ“î•”Ewing “śŽî—Œ•û‚đ‘ΏۂƂ”‚œŒ€‹†‚É‚š‚ą‚Ä‚à•úŽËüŽĄ—Ă‚Æ‰»Šw—Ă–@‚Ć‚ÌȘŽĄ‚ȘŠú‘Ò‚Ć‚«‚é•ń‚Ș‚ ‚éiT2F07504CEV level ⅤjD‚”‚©‚”“î•”Ewing “śŽî‚ÉŒÀ‚Á‚Ä‚Ę‚é‚ƁC•úŽËüŽĄ—Ă‚Æ‰»Šw—Ă–@•č—p‚Ì5 ”N–ł•a¶‘¶—Š‚Í16% ‚Ć‚ ‚èC•úŽËüŽĄ—ÁC‰»Šw—Ă–@CŽèp—Ă–@‚đ‘g‚ʍ‡‚í‚č‚œ5 ”N–ł•a¶‘¶—Š62% ‚ɔ䂔—LˆÓ‚É—ò‚Á‚Ä‚ą‚œ‚Æ‚ł‚ê‚éiT2F12450CEV level ⅣjD
  • ‰~Œ`Ś–E“śŽîˆÈŠO‚Ì“î•”“śŽî‚É‚š‚ą‚ĉ»Šw—Ă–@‚Æ•úŽËüŽĄ—Ă‚É‚æ‚鎥—Ă‚Ì‰Â”\«‚đŽŠ‚·‚à‚Ì‚Æ‚”‚āCŰœ•s”\‚È“î•”“śŽîi‚ą‚ž‚ê‚àŽîᇌa5 cm ˆÈăj‚Éifosfamide ‚É‚æ‚鉻Šw—Ă–@‚Æ’†‰›’l60 Gy ‚Ì•úŽËüŽĄ—Ă‚đs‚ąC5 ”N‹ÇŠ§Œä—Š70% ‚ƁC•úŽËü’P“ÆŽĄ—Ă‚Ìhistorical data ‚ɔ䂌—ǍD‚ȐŹŃ‚Ć‚ ‚Á‚œ‚Æ‚Ì•ń‚Ș‚ ‚éiT2F12379CEV level ⅤjD
  • Űœ•s”\‚È“î•”“śŽî‚ɑ΂·‚éŠÉ˜a“I•úŽËüŽĄ—Âɑ΂·‚é•ń‚͏­‚È‚ą‚ȘC‰Ą–ä‹Ű“śŽî4 —á‚đŠÜ‚ȚŹŽ™ˆ««ŽîᇊłŽÒ40 —á‚ɑ΂”‚Ä5 `30 Gy ‚̊ɘa“IŽĄ—Ă‚đs‚ąC60% ‚ɉœ‚ç‚©‚̏Ǐó‚ÌŒy‰ő‚đ‚Ę‚œ‚Æ‚Ì•ń‚Ș‚ ‚éiT2F12448CEV level ⅤjD
  • •úŽËüŽĄ—Ă•”ˆÊ‚ɐV‚œ‚É”­¶‚·‚é“ńŽŸ”­Šà‚̐łŠm‚È•p“x‚Í•s–Ÿ‚Ć‚ ‚é‚ȘC‚í‚Ș‘‚̃Aƒ“ƒP[ƒg’ȍž‚É‚æ‚é‚ƁC‚·‚Ś‚Ă̈««Žîᇂɑ΂·‚é•úŽËüŽĄ—Ă‚Ì‚€‚ż5 ”N¶‘¶‚”‚œŠłŽÒ‚Ì0.3% ‚É“ńŽŸ”­Šà‚Ș‚Ę‚ç‚ê‚œ‚Æ‚ł‚êC‚»‚Ì“à–ó‚Í“î•”“śŽîC”’ŒŒ•aC‘ć’°ŠàC”畆ŠàCäN㶊àCœŽîá‡‚È‚Ç‚Ć‚ ‚éiT2F12457CEV level ⅣjDŹŽ™‚ɑ΂·‚éÆŽË‚É‚š‚ą‚ẮC“î•”“śŽî‚Ì‚Ę‚ÉŒÀ’è‚·‚錀‹†‚Ć‚Í‚È‚ą‚Ș—LˆÓ‚É2 ŽŸ”­Šà‚̃ŠƒXƒN‚Ș‘‰Á‚·‚émiT2F12451CEV level ⅣjCiT2F12456CEV level ⅣjCiT2F07522CEV level ⅣjnD
  • •úŽËüŽĄ—Ă‚É‚æ‚Á‚ċǏŠ‚Ì‹Ű—Í’á‰șC•‚ŽîCŠÖß‰Â“źˆæ§ŒÀ‚͍‚•p“x‚ɏoŒ»‚·‚邱‚Æ‚ȘŽŠ‚ł‚ê‚Ä‚ą‚é‚ȘCquality of life ‚É‚Í‚Ù‚Æ‚ń‚lje‹ż‚Ș‚È‚ą‚Æ‚ł‚ê‚éiT2F08204CEV level ⅡjD
y•¶@ŒŁz
1j T2F08204
Yang JC, Chang AE, Baker AR et alFRandomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998G16i1jF197-203@mEV level Ⅱn
2j T2F06014
Keus RB, Rutgers EJ, Ho GH et alFLimb-sparing therapy of extremity soft tissue sarcomasFtreatment outcome and long-term functional results. Eur J Cancer 1994G30Ai10jF1459-1463@mEV Level Ⅳn
3j T2F06050
Vraa S, Keller J, Nielsen OS et alFPrognostic factors in soft tissue sarcomasFthe Aarhus experience. Eur J Cancer 1998G34i12jF1876-1882@mEV Level Ⅳn
4j T2F12455
Rydholm A, Gustafson P, Rooser B et alFLimb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol 1991G9i10jF1757-1765@mEV Level Ⅳn
5j T2F12448
Bhasker S, Bajpai V, Turaka AFPalliative radiotherapy in paediatric malignancies. Singapore Med J 2008G49i12jF998-1001@mEV level Ⅴn
6j T2F12457
Sakai K, Kitamura T, Hinata H et alFSecond cancers following radiotherapy of malignant tumors. The second mail survey in Japan. Nippon Igaku Hoshasen Gakkai Zasshi 1986G46i6jF811-818@mEV Level Ⅳn
7j T2F12451
Friedman DL, Whitton J, Leisenring W et alFSubsequent neoplasms in 5-year survivors of childhood cancerFthe Childhood Cancer Survivor Study. J Natl Cancer Inst 2010G102i14jF1083-1095@mEV Level Ⅳn
8j T2F12456
Sultan I, Rihani R, Hazin R et alFSecond malignancies in patients with Ewing Sarcoma Family of TumorsFA population-based study. Acta Oncol 2010G49i2jF237-244@mEV Level Ⅳn
9j T2F07522
Nguyen F, Rubino C, Guerin S et alFRisk of a second malignant neoplasm after cancer in childhood treated with radiotherapyFcorrelation with the integral dose restricted to the irradiated fields. Int J Radiat Oncol Biol Phys 2008G70i3jF908-915@mEV Level Ⅳn
10j T2F12454
Rosenberg SA, Tepper J, Glatstein E et alFThe treatment of soft-tissue sarcomas of the extremitiesFprospective randomized evaluations ofi1jlimbsparing surgery plus radiation therapy compared with amputation andi2jthe role of adjuvant chemotherapy. Ann Surg 1982G196i3jF305-315@mEV level Ⅱn
11j T2F04915
Chung PW, Deheshi BM, Ferguson PC et alFRadiosensitivity translates into excellent local control in extremity myxoid liposarcomaFa comparison with other soft tissue sarcomas. Cancer 2009G115i14jF3254-3261@mEV Level Ⅳn
12j T2F12453
La TH, Wolden SL, Su Z et alFLocal Therapy for Rhabdomyosarcoma of the Hands and FeetFIs Amputation Necessary? A Report from the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2010FmEpub ahead of printnmEV level Ⅲn
13j T2C00342
Donaldson SS, Meza J, Breneman JC et alFResults from the IRS-IV randomized trial of hyperfractionated radiotherapy in children with rhabdomyosarcoma--a report from the IRSG. Int J Radiat Oncol Biol Phys 2001G51i3jF718-728@mEV Level Ⅳn
14j T2F07504
La TH, Meyers PA, Wexler LH et alFRadiation therapy for Ewing's sarcomaFresults from Memorial Sloan-Kettering in the modern era. Int J Radiat Oncol Biol Phys 2006G64i2jF544-550@mEV level Ⅴn
15j T2F12450
El Weshi A, Allam A, Ajarim D et alFExtraskeletal Ewing's sarcoma family of tumours in adultsFanalysis of 57 patients from a single institution. Clin OncoliR Coll Radiolj2010G22i5jF374-381@mEV Level Ⅳn
16j T2F12379
Eckert F, Matuschek C, Mueller AC et alFDefinitive radiotherapy and single-agent radiosensitizing ifosfamide in patients with localized, irresectable soft tissue sarcomaFa retrospective analysis. Radiat Oncol 2010G5F55@mEV level Ⅴn

CQ 2
•â•“I•úŽËüŽĄ—Ă‚ÌŽžŠú‚Í
—v–ń
Grade I
 
•úŽËüŽĄ—Ă‚ÌŽžŠú‚Æ‚”‚ẮCp‘OCp’†CpŒăC‚š‚æ‚Ń‚»‚ê‚ç‚Ì‘g‡‚č‚Ș‚ ‚éD‚ǂ̃^ƒCƒ~ƒ“ƒO‚Ć‚ÌŽĄ—Ă‚ȘĆ‚à—LŒű‚Ć‚ ‚é‚©‚ɂ‚ą‚Ä‚Í–ŸŠm‚ÈŒ‹˜_‚͏o‚Ä‚ą‚È‚ąD
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p‘OÆŽË‚ƏpŒăÆŽË‚Ì”äŠr

p‘OÆŽË‚̏pŒăÆŽË‚ɑ΂·‚é—˜“_‚Æ‚”‚āC①ÆŽË–ì‚đŹ‚ł‚­‚Ć‚«‚éC②ÆŽË‚·‚éŠÖß‚đ­‚È‚­‚Ć‚«‚éC③ÆŽË—Ê‚đ­‚È‚­‚Ć‚«‚éC④p’†‚ÌŽîᇂ̉˜ő‚đŒyŒž‚Ć‚«‚éC⑤ŽîᇏkŹ‚É‚æ‚èŰœ‚̉”\«‚đ‚‚ß‚é‚±‚Æ‚Ș‚Ć‚«‚éC“™‚̈ӌ©‚Ș‚ ‚éiT2F02454CEV level ⅠjD‚Ü‚œpŒăÆŽË‚É‘œ‚ąüˆÛ‰»CŠÖßSkC•‚Žî‚Șp‘OÆŽË‚Ì‚Ù‚€‚Ș­‚È‚ąiT2F11275CEV level ⅡjDÇ—ᐔ‚̏Ź‚ł‚È–łìˆŚŽŽŒ±‚É‚š‚ą‚ďp‘OÆŽË‚Ì—\Œă‚Ș‚í‚ž‚©‚É‚æ‚ą‚Æ‚ą‚€•ń‚Ș‘¶Ę‚·‚éiT2F09914CEV level Ⅱj‚ȘC‚±‚Ì—\Œă‚̍·‚ÍŽîᇊ֘AŽ€–S‚̍·‚Ÿ‚Ż‚Ć‚È‚­CŽîᇎ€ˆÈŠO‚ÌŽ€–S—Š‚̍·‚àŠÖ˜A‚”‚Ä‚ą‚é‚Ɛ„Ž@‚ł‚ê‚Ä‚ą‚éDˆê•ûCp‘OÆŽË‚Ć‚àpŒăÆŽË‚Ć‚à—\Œă‚Í•Ï‚í‚ç‚È‚ą‚Æ‚Ì•ń‚à‚ ‚éiT2F12449CEV level ⅢjD

pŒăÆŽË‚̏p‘OÆŽË‚ɑ΂·‚é—˜“_‚Æ‚”‚āCŽèp‘n‚̍‡•čÇ•p“x‚Ș’á‚ą‚Æ‚Ì•ń‚Ș‚ ‚émiT2F02454CEV level ⅠjCiT2F09914CEV level ⅡjCiT2F12449CEV level ⅢjnD‚Ü‚œp‘O‚ɏƎ˂·‚邱‚Æ‚É‚æ‚èŰœȚ—ż‚̐łŠm‚È‘gDf’f‚â•ȘŽq¶•šŠw“I‰đÍ‚Ș‚Ț‚ž‚©‚”‚­‚È‚é‚ȘCpŒăÆŽË‚Ć‚Í‚±‚Ì‚æ‚€‚È–â‘è‚Ș‚È‚ąiT2F02454CEV level ⅠjD‹ÇŠ§Œä—Š‚ɂ‚ą‚Ă͏p‘O‚àpŒă‚à•Ï‚í‚è‚È‚ą‚Æ‚Ì•ń‚Ș‘œ‚ąmiT2F02454CEV level ⅠjCiT2F09914CEV level ⅡjnD‚ǂ̃^ƒCƒ~ƒ“ƒO‚Ć‚ÌŽĄ—Ă‚ȘĆ‚à—LŒű‚Ć‚ ‚é‚©‚ɂ‚ą‚Ä‚Í–ŸŠm‚ÈŒ‹˜_‚͏o‚Ä‚ą‚È‚ąiT2F02454CEV level ⅠjD

ŹüŒčŽĄ—Ă

ŹüŒčŽĄ—Áibrachytherapyj‚́CŽèp’†‚ÉŽîᇏ°‚ɃJƒe[ƒeƒ‹‚đ‘}“ü‚”CpŒă4`6 “ú‚Ì‘Šú‚ɃCƒŠƒWƒEƒ€üŒč‚đˆÚ‘—‚”‚Ä•”•Ș“I‚ɏƎ˂đŽ{s‚·‚é•û–@‚ƁC‚ˆ««Žîᇂɑ΂”‚ċǏŠ§Œä—Š‚đŒüă‚ł‚č‚éiT2F08180CEV level ⅡjDkŹŽèp‚ƏŹüŒčŽĄ—Ă‚É‚æ‚é‹ÇŠ§Œä—Š‚àC’ʏí‚ÌŠOÆŽË‚É‚æ‚é‹ÇŠ§Œä—Š‚à‚š‚š‚æ‚»90% ‚Ć‚ ‚è“Ż“™‚Ć‚ ‚éiT2F02454CEV level ⅠjD

p’†ÆŽË

p’†ÆŽË‚́Cp‘O‚Ü‚œ‚͏pŒăÆŽË‚ɉÁ‚Š‚ÄŽèp’†‚ÉŠJ‘n‚”‚œ•”•Ș‚É8 `30 Gy ‚Ì1 ‰ńÆŽË‚đ‰Á‚Š‚é•û–@‚ƁCŽć‚Æ‚”‚ÄŒă• –ŒŽîᇂ̋ǏŠ§Œä—Š‚đ‚‚ß‚é–Ú“I‚ĆŽ{s‚ł‚ê‚Ä‚ą‚émiT2F07466CEV level ⅤjCiT2F07444CEV level ⅣjCiT2F03998CEV level ⅡjnD‹ÇŠ§Œä—Š‚ÌŒüă‚ÍŠú‘Ò‚ł‚ê‚é‚ȘCĆI“I‚È—\Œă‚ÌŒüă‚Í–Ÿ‚ç‚©‚Ć‚È‚ąD

y•¶@ŒŁz
1j T2F02454
Strander H, Turesson I, Cavallin-Stahl EFA systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003G42i5-6jF516-531@mEV level Ⅰn
2j T2F11275
Davis AM, O'Sullivan B, Turcotte R et alFLate radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005G75i1jF48-53@mEV level Ⅱn
3j T2F09914
O'Sullivan B, Davis AM, Turcotte R et alFPreoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbsFa randomised trial. Lancet 2002G359i9325jF2235-2241@mEV level Ⅱn
4j T2F12449
Cheng EY, Dusenbery KE, Winters MR et alFSoft tissue sarcomasF preoperative versus postoperative radiotherapy. J Surg Oncol 1996G61i2jF 90-99@mEV level Ⅲn
5j T2F08180
Pisters PW, Harrison LB, Leung DH et alFLong-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996G14i3jF859-868@mEV level Ⅱn
6j T2F07466
Petersen IA, Haddock MG, Donohue JH et alFUse of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys 2002G52i2jF469-475@mEV level Ⅴn
7j T2F07444
Alektiar KM, Hu K, Anderson L et alFHigh-dose-rate intraoperative radiation therapyiHDR-IORTjfor retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000G47i1jF157-163@mEV Level Ⅳn
8j T2F03998
Sindelar WF, Kinsella TJ, Chen PW et alFIntraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993G128i4jF402-410@mEV level Ⅱn

CQ 3
d—±ŽqüŽĄ—Ă‚ÌˆÓ‹`‚Í
—v–ń
Grade C
 
 
d—±ŽqüŽĄ—Ă‚Í‚í‚Ș‘‚𒆐S‚ÉŠJ”­‚ł‚ê‚œ”äŠr“IV‚”‚ą•úŽËüŽĄ—Ă‚Ć‚ ‚èCŒ»ĘÇ—á‚Ș’~Ï‚ł‚ê‚Ä‚ą‚éD“î•”“śŽî‚ÌŽĄ—Ă‚ÉŠÖ‚·‚é˜_•¶•ń‚͏­‚È‚ą‚ȘCŰœ•s”\‚È“î•”“śŽî‚ɑ΂·‚鎥—Ă–@‚Æ‚”‚čl—¶‚”‚Ä‚à‚æ‚ąD
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d—±ŽqüŽĄ—ẤC’Y‘f‚Ȃǂ̃CƒIƒ“‚đ’Ž‚‘Ź‚ɉÁ‘Ź‚”‚œ—±Žqü‚đ—p‚ą‚œ•úŽËüŽĄ—Ă‚Ć‚ ‚èC‚í‚Ș‘‚𒆐S‚É‹ß”N”­“W‚”‚œDü—ʂ̏W’†«‚ÆŽEŚ–EŒű‰Êi¶•šŠw“IŒű‰Êj‚É‚š‚ą‚Ä—D‚ê‚œ“Á’„‚đŽ‚ÂDŰœ•s”\‚ȍœ“î•”“śŽî‚ɑ΂·‚é‹ÇŠ§Œä—Š‚Í1 ”N‚Ć88%C3 ”N‚Ć73% ‚Æ‚ł‚ê”畆áŠQˆÈŠO‚̏d“Ä‚È•›ì—p‚͏­‚È‚ąDŰœ•s”\‚ÈŒă• –Œ“śŽî24 —á‚ÉŒÀ‚Á‚Ä‚Ę‚é‚ƁC5 ”N‹ÇŠ§Œä—Š‚Í69% ‚ƏÁ‰»ŠÇúE‚Ȃǂ̏d“ĂȏáŠQ‚͐¶‚¶‚È‚©‚Á‚œmiT2F12452CEV level ⅣjCiT2F07545CEV level ⅣjnD‘ΏۂƂ”‚œÇ—á‚ȘŽèp•s”\‚ȍœ”ŐŽü•Ó‚Ȃǂ̏Ǘá‚Ć‚ ‚Á‚œ‚±‚Æ‚đ‰Á–Ą‚·‚ê‚΁CĄŒă‚àl—¶‚ł‚ê‚Ä‚æ‚ą‹ÇŠŽĄ—Ă–@‚Ć‚ ‚émiT2F12452CEV level ⅣjCiT2F07545CEVlevel ⅣjnD

y•¶@ŒŁz
1j T2F12452
Kamada T, TsujⅡ H, Tsuji H et alFEfficacy and safety of carbon ion radiotherapy in bone and soft tissue sarcomas. J Clin Oncol 2002G20i22jF 4466-4471@mEV Level Ⅳn
2j T2F07545
Serizawa I, Kagei K, Kamada T et alFCarbon ion radiotherapy for unresectable retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2009G75i4jF1105-1110@mEV Level Ⅳn

‘æ11 Í@‚»‚Ì‘Œ‚ÌŽĄ—Ă

Clinical QuestionE„§ˆê——‚Ö


CQ 1
‰·”M—Ă–@‚̈Ӌ`‚Í
—v–ń
Grade C
 
œ”ՁE• •”E‘ÌŠČ‚Ì“î•”“śŽî‚ɑ΂·‚é•â•‰·”M‰»Šw—Ă–@‚́C•â•‰»Šw—Ă–@’P“Æ‚Æ”äŠr‚”‚Ä–ł‘ˆ«¶‘¶ŠúŠÔ‚đ‚̂΂·‰Â”\«‚Ș‚ ‚é‚ȘC‚í‚Ș‘‚Ć‚ÌŽÀŽ{—á‚͏­‚È‚ąD
y‰đ@àz

‰·”M—Ă–@‚É‚Í‘Sg‚đ‰Á‰·‚·‚é•û–@i‘Sg‰·”M—Ă–@jiT2F10512CEV level Ⅳj‚ƁCŠà‚â‚»‚Ì‹ß‚­‚đ‰·‚ß‚é•û–@i‹ÇŠ‰·”M—Ă–@j‚Ș‚ ‚é‚ȘC‹ÇŠ‰·”M—Ă–@‚Ș‘œ‚­s‚í‚ê‚Ä‚ą‚éD“î•”“śŽî‚ɑ΂·‚é‹ÇŠ‰·”M—Ă–@‚ɂ́Cƒ}ƒCƒNƒ”g‚â“dŽ„”g‚đ—p‚ą‚œ‘•’u‚Ć‹ÇŠ‚đ‘ÌŠO‚©‚牷‚ß‚é•û–@‚ƁCŽlŽˆ‚ɍs‚€HILPihyperthermic isolated limb perfusionj‚È‚Ç‚Ș‚ ‚èCŠeX‰»Šw—Ă–@E•úŽËüŽĄ—ÁEŠO‰È“IŰœ‚Æ‘g‚ʍ‡‚ł‚ê‚ÄŽg—p‚ł‚ê‚Ä‚ą‚éiT2F12461CEV level ⅣjDŠCŠO‚Ć‘œ‚­s‚í‚ê‚Ä‚ą‚éHILP ‚́C‚»‚Ì‘œ‚­‚Ș‹ÇŠŸó—Ź‚ÉTNFitumor necrosis factorjƒż‚Æmelphalan ‚ȘŽg—p‚ł‚ê‚Ä‚š‚èiT2F00224CEV level ⅣjC‚‚ą‘tŒű—Š‚Ș•ń‚ł‚ê‚Ä‚ą‚é‚ȘC‚í‚Ș‘‚Ć‚ÌŽÀŽ{‚Í‚Ț‚ž‚©‚”‚ąD‰·”M—Ă–@‚ɂ‚ą‚Ä‚Ì”äŠrŽŽŒ±‚Ć—LŒű«‚ȘŠm”F‚ł‚ê‚œ‚̂́C‘ÌŠO‚©‚ç‚̋ǏŠ‰·”M—Ă–@‚Ì‚Ę‚Ć‚ ‚èi‰ș‹LƒGƒrƒfƒ“ƒXŽQÆjiT2F12336CEV level ⅡjC‚ą‚ž‚ê‚Ì•û–@‚à‚í‚Ș‘‚Ć‚Í‚ ‚܂蕁‹y‚”‚Ä‚ą‚È‚ąD

yƒGƒrƒfƒ“ƒXz
  • •â•‰·”M‰»Šw—Ă–@‚ÉŠÖ‚·‚é—Bˆê‚̃‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ș•ń‚ł‚ê‚Ä‚ą‚éiT2F12336CEV level ⅡjDƒRƒ“ƒgƒ[ƒ‹ŒQ172 —á‚É‚ÍEIAietoposide, ifosfamide, doxorubicinj‚É‚æ‚ép‘OpŒă‚̕⏕‰»Šw—Ă–@‚Ì‚Ę‚Șs‚í‚êCŽŽŒ±ŽĄ—ĂŒQ169 —á‚É‚ÍŠeX‚ÌEIA ‚ÉBSD-2000 ‚đ—p‚ą‚œRHTiregional hyperthermiaj‚Ș’ljÁ‚ł‚ê‚œD‚»‚ÌŒ‹‰ÊClocal progression-free survivalihazard ratioFHR 0.58, 95%CI 0.41`0.84j‚Ædisease-free survivaliHR 0.70, 95%CI 0.54 `0.92j‚Ș—LˆÓ‚ɉ„’·‚”‚œDƒTƒuƒOƒ‹[ƒv‰đÍ‚É‚š‚ą‚ÄŽlŽˆ”­¶—á‚Ć‚Í‚±‚ê‚ç‚̐¶‘¶ŠúŠÔ‚̉„’·‚ÍŰ–Ÿ‚ł‚ê‚È‚©‚Á‚œDˆê•ûCœ”ՁE• •”E‘ÌŠČ‚đŠÜ‚Ț”ńŽlŽˆ—á‚Ć‚Ílocal progression-freesurvivaliHR 0.60, 95%CI 0.40`0.90j‚Ædisease-free survivaliHR 0.64, 95%CI 0.46`0.90j‚Ș—LˆÓ‚ɉ„’·‚”‚Ä‚ą‚œ
y•¶@ŒŁz
1j T2F10512
Westermann AM, Wiedemann GJ, Jager E et alFA Systemic Hyperthermia Oncologic Working Group trial. Ifosfamide, carboplatin, and etoposide combined with 41.8 degrees C whole-body hyperthermia for metastatic soft tissue sarcoma. Oncology 2003G64i4jF312-321@mEV Level Ⅳn
2j T2F12461
Otsuka T, Yonezawa M, Kamiyama F et alFResults of surgery and radiohyperthermo-chemotherapy for patients with soft-tissue sarcoma. Int J Clin Oncol 2001G6i5jF253-258@mEV Level Ⅳn
3j T2F00224
Eggermont AM, Schraffordt Koops H, Klausner JM et alFIsolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience. Ann Surg 1996G224i6jF756-64Gdiscussion 64-65@mEV Level Ⅳn
4j T2F12336
Issels RD, Lindner LH, Verweij J et alFNeo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcomaFa randomised phase 3 multicentre study. Lancet Oncol 2010G11i6jF561-570mEV level Ⅱn

CQ 2
–Ɖu—Ă–@‚̈Ӌ`‚Í
—v–ń
Grade I
Œ»Žž“_‚Ć“î•”“śŽî‚ɑ΂·‚é–Ɖu—Ă–@‚ÌŒű‰Ê‚Í–Ÿ‚ç‚©‚Ć‚Í‚È‚ąD
y‰đ@àz

“î•”“śŽî‚ɑ΂·‚é–Ɖu—Ă–@‚́CWT1 ‚È‚Ç‚ÌŠàRŒŽCSYT-SSX ‚È‚Ç‚Ì‘gDŒ^‚É“ÁˆÙ“I‚È—Z‡’`”’C‚ ‚é‚ą‚ÍŽîᇍŚ–E‚»‚Ì‚à‚Ì‚đ—p‚ą‚œƒƒNƒ`ƒ“—Ă–@miT2F12460CEV level ⅤjCiT2F05281CEV level ⅤjCiT2F04929CEV level ⅤjCiT2F12459CEV level ⅤjnCŠàRŒŽ‚ɑ΂·‚éR‘Ì—Ă–@miT2F05016CEV level ⅤjCiT2F00477CEV level ⅤjnCIL-2 ‚đ—p‚ą‚œƒTƒCƒgƒJƒCƒ“—Ă–@iT2F08721CEV level ⅤjCLeuvectin ‚đ—p‚ą‚œIL2 ˆâ“`ŽqŽĄ—ÁiT2F08224CEV level Ⅳj‚È‚Ç‚Ș•ń‚ł‚ê‚Ä‚ą‚é‚ȘC‚Ç‚ê‚à­”—á‚ɑ΂·‚é‘æ‡T‘ŠŽŽŒ±‚à‚”‚­‚Í‘æⅠ / Ⅱ‘ŠŽŽŒ±‚Ć‚ ‚èCŽĄ—Ă•û–@‚à‘œŠò‚É‚í‚œ‚é‚œ‚ߊm—§‚ł‚ê‚œ‚à‚Ì‚Í‚È‚ąD‚í‚Ș‘‚Ć‚à”Œ‚Ì—Ő°ŽŽŒ±‚Șis’†‚Ć‚ ‚é‚Ì‚ĆCŒ»Žž“_‚Ć‚Í–Æ‰u—Ă–@‚Í‚±‚ê‚ç—Տ°ŽŽŒ±‚͈͓̔à‚ƍs‚í‚ê‚é‚Ś‚«‚à‚̂ƍl‚Š‚éD

y•¶@ŒŁz
1j T2F12460
Ohta H, Hashii Y, Yoneda A et alFWT1iWilms tumor 1jpeptide immunotherapy for childhood rhabdomyosarcomaFa case report. Pediatr Hematol Oncol 2009G26i1jF74-83@mEV level Ⅴn
2j T2F05281
Mackall CL, Rhee EH, Read EJ et alFA pilot study of consolidative immunotherapy in patients with high-risk pediatric sarcomas. Clin Cancer Res 2008G14i15jF4850-4858@mEV level Ⅴn
3j T2F04929
Dillman R, Barth N, Selvan S et alFPhase I/Ⅱ trial of autologous tumor cell line-derived vaccines for recurrent or metastatic sarcomas. Cancer Biother Radiopharm 2004G19i5jF581-588@mEV level Ⅴn
4j T2F12459
Kawaguchi S, Wada T, Ida K et alFPhase I vaccination trial of SYT-SSX junction peptide in patients with disseminated synovial sarcoma. J Transl Med 2005G3i1jF1@mEV level Ⅴn
5j T2F05016
Choi BS, Sondel PM, Hank JA et alFPhase I trial of combined treatment with ch14.18 and R24 monoclonal antibodies and interleukin-2 for patients with melanoma or sarcoma. Cancer Immunol Immunother 2006G55i7jF761-774@mEV level Ⅴn
6j T2F00477
Casper ES, Cordon-Cardo C, Houghton AN et alFBiological study of R24 mouse monoclonal antibody in patients undergoing thoracotomy for pulmonary metastases from soft tissue sarcoma. Cancer Invest 1994G12i1jF 20-25@mEV level Ⅴn
7j T2F08721
Le Cesne A, Vassal G, Farace F et alFCombination interleukin-2 and doxorubicin in advanced adult solid tumorsFcircumvention of doxorubicin resistance in soft-tissue sarcoma? J Immunother 1999G22i3jF268-277@mEV level Ⅴn
8j T2F08224
Galanis E, Hersh EM, Stopeck AT et alFImmunotherapy of advanced malignancy by direct gene transfer of an interleukin-2 DNA/DMRIE/DOPE lipid complexFphase I/Ⅱ experience. J Clin Oncol 1999G17i10jF3313-3323mEV Level Ⅳn

‘æ12 Í@“î•”“śŽî“]ˆÚÇ—á

Clinical QuestionE„§ˆê——‚Ö


CQ 1
“]ˆÚ•a‘ƒ‚ɑ΂·‚éŠO‰È“IŰœ‚̈Ӌ`‚Í
—v–ń
Grade B
 
’P”­‚̃Šƒ“ƒpß“]ˆÚC‘Œ‘ŸŠí“]ˆÚ‚Ì‚È‚ąŠź‘SŰœ‰Â”\‚È”x“]ˆÚ‚́CŰœ‚đs‚€‚±‚Æ‚Ć—\Œă‰ü‘P‚ȘŠú‘Ò‚Ć‚«C“KŰ‚ÈŠłŽÒ‘I‘đ‚đs‚Š‚ΊO‰ÈŰœ‚̈Ӌ`‚Í‘ć‚«‚ąD
y‰đ@àz

“î•”“śŽî‚É‚š‚Ż‚é“]ˆÚ•a‘ƒ‚Æ‚”‚ẮC”x“]ˆÚmiT2F00440CEV level Ⅳ jCiT2F12462CEV level ⅣjCiT2F04640CEV level ⅣjCiT2F12463CEV level ⅣjCiT2F05415CEV level Ⅳjn‚ȘĆ‚à•p“x‚Ș‚‚­C‚»‚Ì‘ŒC”畆C“î•”‘gDiT2F04692CEV level ⅣjCƒŠƒ“ƒpßiT2F00648CEV level ⅣjCœiT2F12464CEV level ⅤjC“™‚É“]ˆÚ‚ȘŒ©‚ç‚ê‚éD”x“]ˆÚ‚đ‚«‚œ‚”‚â‚·‚ą“î•”“śŽî‚͍‚ˆ««“xC”ń‰~Œ`Ś–E“śŽîCŠŠ–Œ“śŽîCƒTƒCƒY‘ći5 cm ’Žj‚Æ‚ą‚€•ń‚Ș‚ ‚éiT2F03505CEV level ⅣjD“]ˆÚ•a‘ƒ‚Í‚»‚̏oŒ»ŽžŠú‚â•”ˆÊC‘œ”­‚©’P”­‚©‚ȂǏ󋔂ɑœ—l«‚Ș‚ ‚èC‰æˆê“I‚È•W€“IŽĄ—ĂŽwj‚Í‚È‚ąD”x“]ˆÚ‚ɂ‚ą‚Ä‚ÍŠź‘SŰœ‚đs‚€‚±‚Æ‚Ć’·Šú¶‘¶‚·‚éÇ—á‚Ș•ń‚ł‚ê‚Ä‚ą‚éiT2F12462CEV level ⅣjD‚Ü‚œC”x“]ˆÚÇ—á‚Ì—\Œă—ǍD‚ȈöŽq‚Æ‚”‚āC“]ˆÚ‘ƒŠź‘SŰœC“]ˆÚoŒ»‚Ü‚Ć‚Ì’·Šú–ł•a¶‘¶i1 `2.5 ”NjC40 ÎˆÈ‰șC‘gDŠw“I’ራ«“xC”x“]ˆÚŒÂ”… 3 ŒÂC“™‚Ș•ń‚ł‚ê‚Ä‚ą‚émiT2F12462CEV level ⅣjCiT2F04640CEV level ⅣjCiT2F05415CEV level ⅣjnDƒŠƒ“ƒpß“]ˆÚ‚ɂ‚ą‚ẮCŒÇ—§«‚̏Ǘá‚Ć‚Í—\Œă‚Ș‚æ‚ą‚Æ‚·‚é•ń‚Ș‚ ‚éiT2F04692CEV level ⅣjDˆÈă‚Ì‚æ‚€‚É—\Œă—ǍD‚ȈöŽq‚đŽ‚ÂÇ—á‚ɂ‚ą‚Ä‚ÍŠO‰È“IŰœ‚đs‚€‚±‚Æ‚Ș„§‚Ć‚«‚éD‚Ü‚œŰœˆÈŠO‚ÌŽĄ—Ă•û–@‚Æ‚”‚ẮCƒ‰ƒWƒI”gŽĄ—Ă‚â’èˆÊ•úŽËüŽĄ—Ă‚È‚Ç‚àŽŽs‚ł‚ê‚Ä‚ą‚éD

y•¶@ŒŁz
1j T2F00440
Ueda T, Uchida A, Kodama K et alFAggressive pulmonary metastasectomy for soft tissue sarcomas. Cancer 1993G72i6jF1919-1925@mEV Level Ⅳn
2j T2F12462
Billingsley KG, Burt ME, Jara E et alFPulmonary metastases from soft tissue sarcomaFanalysis of patterns of diseases and postmetastasis survival. Ann Surg 1999G229i5jF602-610Gdiscussion 10-12@mEV Level Ⅳn
3j T2F04640
van Geel AN, Pastorino U, Jauch KW et alFSurgical treatment of lung metastasesFThe European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients. Cancer 1996G77i4jF675-682@mEV Level Ⅳn
4j T2F12463
Rehders A, Hosch SB, Scheunemann P et alFBenefit of surgical treatment of lung metastasis in soft tissue sarcoma. Arch Surg 2007G142i1jF70-75G discussion 6@mEV Level Ⅳn
5j T2F05415
Kawai A, Fukuma H, Beppu Y et alFPulmonary resection for metastatic soft tissue sarcomas. Clin Orthop Relat Res 1995G310F188-193@mEV Level Ⅳn
6j T2F04692
Billingsley KG, Lewis JJ, Leung DH et alFMultifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer 1999G85i2jF389-395@mEV Level Ⅳn
7j T2F00648
Riad S, Griffin AM, Liberman B et alFLymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 2004G426F129-134@mEV Level Ⅳn
8j T2F12464
Yoshikawa H, Ueda T, Kudawara I et alFSurgical treatment for skeletal metastases from soft tissue sarcomasFexperience with 23 lesions in 20 patients. Sarcoma 1998G2i2jF107-114@mEV level Ⅴn
9j T2F03505
Gadd MA, Casper ES, Woodruff JM et alFDevelopment and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993G218i6jF705-712@mEV Level Ⅳn

CQ 2
“]ˆÚÇ—á‚ɑ΂·‚鉻Šw—Ă–@‚̈Ӌ`‚Í
—v–ń
Grade B
 
 
—\Œă‰ü‘P‚đŠú‘Ò‚”‚ÄŽ{s‚·‚é‚È‚ç‚Îdoxorubicin ‚𒆐S‚Æ‚”‚œ‰»Šw—Ă–@‚Ș„§‚ł‚ê‚éD‚œ‚Ÿ‚”ŠO‰È“IŰœ‚Ș‚Ć‚«‚È‚Ż‚ê‚Ή»Šw—Ă–@‚Ì‚Ę‚Ć‚ÍȘŽĄ“IˆÓ–Ą‚É–R‚”‚ąD“]ˆÚ‘ƒ‚̏󋔂đ‚Ę‚È‚Ș‚çCŠłŽÒ‚Æ‘Š’k‚̏ă‚ĆŽ{s‚ł‚ê‚é‚Ś‚«‚Ć‚ ‚éD
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1j T2F12384
Grimer R, Judson I, Peake D et alFGuidelines for the management of soft tissue sarcomas. Sarcoma 2010G2010F506182
2j T2F12079
Casali PG, Blay JYFSoft tissue sarcomasFESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010G21 Suppl 5Fv198-203.
3j T2C00168
Bramwell V, Anderson D, Charette M et alFDoxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database 2003i3jF CD003293@mEV level Ⅰn
4j T2F05094
Verma S, Younus J, Stys-Norman D et alFMeta-analysis of ifosfamide-based combination chemotherapy in advanced soft tissue sarcoma. Cancer Treat Rev 2008G34i4jF339-347@mEV level Ⅰn
5j T2F08366
Lorigan P, Verweij J, Papai Z et alFPhase Ⅲ trial of two investigational schedules of ifosfamide compared with standard-dose doxorubicin in advanced or metastatic soft tissue sarcomaFa European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study. J Clin Oncol 2007G25i21jF3144-3150@mEV level Ⅱn
6j T2C00387
Crist W, Gehan EA, Ragab AH et alF The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol 1995G13i3jF610-630@mEV level Ⅱn
7j T2C00408
Oberlin O, Rey A, Lyden E et alFPrognostic factors in metastatic rhabdomyosarcomasFresults of a pooled analysis from United States and European cooperative groups. J Clin Oncol 2008G26i14jF2384-2389@mEV level Ⅲn
8j T2C00444
Rodeberg D, Arndt C, Breneman J et alFCharacteristics and outcomes of rhabdomyosarcoma patients with isolated lung metastases from IRS-IV. J Pediatr Surg 2005G40i1jF256-262@mEV level Ⅴn
9j T2F08396
Sleijfer S, Ray-Coquard I, Papai Z et alFPazopanib, a multikinase angiogenesis inhibitor, in patients with relapsed or refractory advanced soft tissue sarcomaFa phase Ⅱ study from the European organisation for research and treatment of cancer-soft tissue and bone sarcoma groupiEORTC study 62043j. J Clin Oncol 2009G27i19jF3126-3132@mEV level Ⅲn